Basic Information
| Provider Information | |||||||||
| NPI: | 1134569627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISEN | ||||||||
| FirstName: | KANWALROOP | ||||||||
| MiddleName: | |||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7471 N FRESNO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937202457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594364500 | ||||||||
| FaxNumber: | 5592611526 | ||||||||
| Practice Location | |||||||||
| Address1: | 7471 N FRESNO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937202457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594364500 | ||||||||
| FaxNumber: | 5592611526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2013 | ||||||||
| LastUpdateDate: | 07/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 23181 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ZZZ21572Z | 01 | CA | MEDICARE GROUP PTAN | OTHER | GR0043790 | 05 | CA | MEDICAID |