Provider Demographics
NPI:1740460773
Name:KHANGURA, LORETTA LOUISE (RN)
Entity type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:LOUISE
Last Name:KHANGURA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LORETTA
Other - Middle Name:LOUISE
Other - Last Name:UHLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1140 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-1257
Mailing Address - Country:US
Mailing Address - Phone:209-394-9313
Mailing Address - Fax:
Practice Address - Street 1:1140 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334-1257
Practice Address - Country:US
Practice Address - Phone:209-394-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2009-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467117163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA467117OtherCALIFORNIA BRN