Provider Demographics
NPI:1659798031
Name:KAUR, MANINDER (APN)
Entity Type:Individual
Prefix:
First Name:MANINDER
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 MDOS/SGOM
Mailing Address - Street 2:4881 SUGAR MAPLE DRIVE
Mailing Address - City:WRIGHT PATTERSON AFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433
Mailing Address - Country:US
Mailing Address - Phone:937-713-1829
Mailing Address - Fax:
Practice Address - Street 1:88 MDOS/SGOM
Practice Address - Street 2:4881 SUGAR MAPLE DRIVE
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433
Practice Address - Country:US
Practice Address - Phone:937-713-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019916363L00000X, 363L00000X
OHCTP.021377363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner