Healthcare Provider Details

I. General information

NPI: 1841960770
Provider Name (Legal Business Name): HERLEEN KAUR CHATTHA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 E HARDING WAY
STOCKTON CA
95204-6110
US

IV. Provider business mailing address

582 E HARDING WAY
STOCKTON CA
95204-6110
US

V. Phone/Fax

Practice location:
  • Phone: 209-442-6077
  • Fax: 844-226-9193
Mailing address:
  • Phone: 209-442-6077
  • Fax: 844-226-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: