Healthcare Provider Details

I. General information

NPI: 1376284265
Provider Name (Legal Business Name): SUKHVINDER KAUR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/30/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE STE 445
MODESTO CA
95350-4573
US

IV. Provider business mailing address

1769 SHELLSTONE WAY
RIPON CA
95366-9654
US

V. Phone/Fax

Practice location:
  • Phone: 209-571-1693
  • Fax: 209-571-0326
Mailing address:
  • Phone: 209-814-6634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95018288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: