Provider Demographics
NPI:1821579418
Name:SAMRAN, PUVANDEEP KAUR (NP)
Entity Type:Individual
Prefix:
First Name:PUVANDEEP
Middle Name:KAUR
Last Name:SAMRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PUVANDEEP
Other - Middle Name:KAUR
Other - Last Name:SRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:18702 AVENUE 14
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-9438
Mailing Address - Country:US
Mailing Address - Phone:559-457-8280
Mailing Address - Fax:
Practice Address - Street 1:18702 AVENUE 14
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-9438
Practice Address - Country:US
Practice Address - Phone:559-457-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95038210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily