Basic Information
| Provider Information | |||||||||
| NPI: | 1942866207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANHAS | ||||||||
| FirstName: | JANISHA | ||||||||
| MiddleName: | KAUR | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MB, BCH, BAO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 EXCELSIOR BLVD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | ST. LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529937711 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6600 EXCELSIOR BOULEVARD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | ST. LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554264744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529937705 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2019 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/13/2020 | ||||||||
| NPIReactivationDate: | 07/23/2020 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.