Healthcare Provider Details

I. General information

NPI: 1487091708
Provider Name (Legal Business Name): NIKKIE RANDHAWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date: 03/27/2014
Reactivation Date: 08/21/2017

III. Provider practice location address

204-145 13TH ST E
NORTH VANCOUVER BC
V7L2L4
CA

IV. Provider business mailing address

22 MCCALLUM ROAD
ABBOTSFORD BRITISH COLUMBIA
V2S8A1
CA

V. Phone/Fax

Practice location:
  • Phone: 604-924-4009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberLP03907
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: