Provider Demographics
NPI:1912139114
Name:SAMRA, RUPINDERJIT KAUR (NP)
Entity Type:Individual
Prefix:
First Name:RUPINDERJIT
Middle Name:KAUR
Last Name:SAMRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RUPINDERJIT
Other - Middle Name:K
Other - Last Name:SAMRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:4150 V ST STE G400
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-8464
Mailing Address - Fax:916-734-7953
Practice Address - Street 1:4150 V ST STE G400
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-8464
Practice Address - Fax:916-734-7953
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA629802163W00000X
CA3026364S00000X
CA17660363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist