Basic Information
| Provider Information | |||||||||
| NPI: | 1962977405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUR | ||||||||
| FirstName: | ASHWINDER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 HARRIS AVE STE A | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958383249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166496793 | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 HARRIS AVE STE A | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958383249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166496793 | ||||||||
| FaxNumber: | 9169297411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2018 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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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 | 164X00000X | 282607 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
ID Information
| ID | Type | State | Issuer | Description | 123456 | 01 | MILITARY MEDICAL | OTHER |