MEDICARE: AMANDEEP KAUR PHANGUREH FNP-C

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	207Q00000X	Family Medicine Physician	819874	NV

General Provider Information

NPI Number	:	1760198469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDEEP KAUR PHANGUREH FNP-C

Provider Business Mailing Address
First Line	:	10747 SHASTA GLOW CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-8691
Country	:	US
Telephone Number	:	408-547-7957
Fax Number	:

Provider Business Practice Location Address
First Line	:	8766 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-6700
Country	:	US
Telephone Number	:	408-547-7957
Fax Number	:

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

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	01/25/2023

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