Provider Demographics
NPI:1609406289
Name:SINGH, AMANDEEP (LVN)
Entity Type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 N GREGORY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-0455
Mailing Address - Country:US
Mailing Address - Phone:559-312-3540
Mailing Address - Fax:
Practice Address - Street 1:4303 N GREGORY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-0455
Practice Address - Country:US
Practice Address - Phone:559-312-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283143164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse