Provider Demographics
NPI:1245007731
Name:BATH, GAGANDEEP KAUR
Entity type:Individual
Prefix:MRS
First Name:GAGANDEEP
Middle Name:KAUR
Last Name:BATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22850 NE 8TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7256
Mailing Address - Country:US
Mailing Address - Phone:425-898-0305
Mailing Address - Fax:
Practice Address - Street 1:22850 NE 8TH ST STE 103
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7256
Practice Address - Country:US
Practice Address - Phone:428-898-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61488051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily