Healthcare Provider Details

I. General information

NPI: 1134996127
Provider Name (Legal Business Name): NIMRIT KAUR SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7757 W DEER VALLEY RD STE 275
PEORIA AZ
85382-2130
US

IV. Provider business mailing address

435 N 5TH ST
PHOENIX AZ
85004-2157
US

V. Phone/Fax

Practice location:
  • Phone: 623-878-2800
  • Fax:
Mailing address:
  • Phone: 602-827-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: