Healthcare Provider Details

I. General information

NPI: 1548087141
Provider Name (Legal Business Name): KAJAL PREM DHAWAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BISCAYNE BLVD
MIAMI FL
33132-1449
US

IV. Provider business mailing address

3425 WISCONSIN AVE APT 24
VICKSBURG MS
39180-5345
US

V. Phone/Fax

Practice location:
  • Phone: 877-870-0323
  • Fax: 866-427-3798
Mailing address:
  • Phone:
  • Fax: 866-427-3798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906954
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: