Provider Demographics
NPI:1134493802
Name:VIRDI, CHANDNI KAUR (ARNP)
Entity type:Individual
Prefix:
First Name:CHANDNI
Middle Name:KAUR
Last Name:VIRDI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101299
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-0005
Mailing Address - Country:US
Mailing Address - Phone:206-805-8885
Mailing Address - Fax:206-522-5151
Practice Address - Street 1:300 LILLY RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5428
Practice Address - Country:US
Practice Address - Phone:360-252-9777
Practice Address - Fax:360-252-9778
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60266723363LF0000X
WAAP6026-6723363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily