Provider Demographics
NPI:1477924959
Name:KHALSA, AMRIT KAUR (RN IBCLC)
Entity Type:Individual
Prefix:MS
First Name:AMRIT
Middle Name:KAUR
Last Name:KHALSA
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2734
Mailing Address - Country:US
Mailing Address - Phone:510-235-4878
Mailing Address - Fax:
Practice Address - Street 1:2218 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530
Practice Address - Country:US
Practice Address - Phone:510-235-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222732163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0480927OtherLACTATION NURSE SPECIALIST