Provider Demographics
NPI:1437424447
Name:ATWAL-KHANNA, SANJEEVAN (NP)
Entity Type:Individual
Prefix:
First Name:SANJEEVAN
Middle Name:
Last Name:ATWAL-KHANNA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 EYE ST # 100
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5208
Mailing Address - Country:US
Mailing Address - Phone:661-310-3688
Mailing Address - Fax:661-368-0826
Practice Address - Street 1:1707 EYE ST # 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-310-3688
Practice Address - Fax:661-368-0826
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily