Provider Demographics
NPI:1528575461
Name:DHALIWAL, HARPREET (FNP-C)
Entity Type:Individual
Prefix:
First Name:HARPREET
Middle Name:
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 W GRANT LINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7337
Mailing Address - Country:US
Mailing Address - Phone:209-207-9969
Mailing Address - Fax:209-879-9629
Practice Address - Street 1:1341 HISTORICAL PLAZA WAY
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5064
Practice Address - Country:US
Practice Address - Phone:209-824-1893
Practice Address - Fax:209-825-9605
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-31
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95006555OtherFNP LICENSE NUMBER