Provider Demographics
NPI:1255104659
Name:GREWAL, SIMRANJEET KAUR
Entity type:Individual
Prefix:
First Name:SIMRANJEET
Middle Name:KAUR
Last Name:GREWAL
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 1:251 REECE CT
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9213
Mailing Address - Country:US
Mailing Address - Phone:209-505-0018
Mailing Address - Fax:
Practice Address - Street 1:801 17TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1243
Practice Address - Country:US
Practice Address - Phone:209-251-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024604363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner