1144963018 NPI number — MANMEET KAUR CHAHAL

Table of content: MANMEET KAUR CHAHAL (NPI 1144963018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144963018 NPI number — MANMEET KAUR CHAHAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAHAL
Provider First Name:
MANMEET
Provider Middle Name:
KAUR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144963018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11603 W CALAVAR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL MIRAGE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85335-5097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-760-8928
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9128 N 64TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARADISE VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85253-1841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-920-3318
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN191797 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN191797 . This is a "ARIZONA STATE BOARD OF NURSING" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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