Provider Demographics
NPI:1184493181
Name:GREWAL, MANDEEP KAUR (FNP)
Entity type:Individual
Prefix:
First Name:MANDEEP
Middle Name:KAUR
Last Name:GREWAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 LOTUS POND CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-4338
Mailing Address - Country:US
Mailing Address - Phone:916-716-7275
Mailing Address - Fax:
Practice Address - Street 1:4905 LOTUS POND CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-4338
Practice Address - Country:US
Practice Address - Phone:916-716-7275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily