Provider Demographics
NPI:1881324374
Name:DHALIWAL, AMANDEEP KAUR (RN)
Entity type:Individual
Prefix:MRS
First Name:AMANDEEP
Middle Name:KAUR
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:AMANDEEP
Other - Middle Name:
Other - Last Name:DHALIWAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3772 VERNAZZA CT MANTECA CA 95337
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337
Mailing Address - Country:US
Mailing Address - Phone:510-304-8612
Mailing Address - Fax:
Practice Address - Street 1:1923 COFFEE RD # 12
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2708
Practice Address - Country:US
Practice Address - Phone:209-409-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95020820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily