MEDICARE: VANDANA KUMAR NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95018424	CA

General Provider Information

NPI Number	:	1184395147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANDANA KUMAR NP

Provider Business Mailing Address
First Line	:	3505 LONE TREE WAY
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94509-6067
Country	:	US
Telephone Number	:	925-303-4780
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 LONE TREE WAY
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94509-6067
Country	:	US
Telephone Number	:	925-303-4780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	09/21/2021

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