Healthcare Provider Details

I. General information

NPI: 1508226903
Provider Name (Legal Business Name): MANVINDER KAUR RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

IV. Provider business mailing address

3134 N HANOVER AVE
FRESNO CA
93722-4690
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number795582
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95005135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: