Provider Demographics
NPI:1700250883
Name:GREWAL, ANEET K (ARNP)
Entity Type:Individual
Prefix:
First Name:ANEET
Middle Name:K
Last Name:GREWAL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANEET
Other - Middle Name:K
Other - Last Name:DEOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4422 MEADOW VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4422 MEADOW VALLEY CIR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-6671
Practice Address - Country:US
Practice Address - Phone:707-816-0833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily