Healthcare Provider Details

I. General information

NPI: 1376113498
Provider Name (Legal Business Name): SUPNEET KAUR SANDHU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 TRUXTUN AVE STE 160
BAKERSFIELD CA
93309-0693
US

IV. Provider business mailing address

6001 TRUXTUN AVE STE 160
BAKERSFIELD CA
93309-0693
US

V. Phone/Fax

Practice location:
  • Phone: 661-588-4001
  • Fax: 661-588-4042
Mailing address:
  • Phone: 661-588-4001
  • Fax: 661-588-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: