Healthcare Provider Details

I. General information

NPI: 1821579418
Provider Name (Legal Business Name): PUVANDEEP KAUR SAMRAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PUVANDEEP KAUR SRAN NP

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18702 AVENUE 14
MADERA CA
93637-9438
US

IV. Provider business mailing address

18702 AVENUE 14
MADERA CA
93637-9438
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-8280
  • Fax:
Mailing address:
  • Phone: 559-457-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95011162
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: