Provider Demographics
NPI:1700249471
Name:PAVNEET GREWAL ENTERPRISE INC
Entity Type:Organization
Organization Name:PAVNEET GREWAL ENTERPRISE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAVNEET
Authorized Official - Middle Name:
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:214-449-8322
Mailing Address - Street 1:5803 MIDNIGHT MOON DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0715
Mailing Address - Country:US
Mailing Address - Phone:214-449-8322
Mailing Address - Fax:
Practice Address - Street 1:5803 MIDNIGHT MOON DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0715
Practice Address - Country:US
Practice Address - Phone:214-449-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty