Healthcare Provider Details

I. General information

NPI: 1841768108
Provider Name (Legal Business Name): TAJINDER KAUR KULLAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JAN CT STE 150
CHICO CA
95928-4418
US

IV. Provider business mailing address

35 JAN CT STE 150
CHICO CA
95928-4418
US

V. Phone/Fax

Practice location:
  • Phone: 530-899-8853
  • Fax:
Mailing address:
  • Phone: 530-899-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: