Healthcare Provider Details

I. General information

NPI: 1780385872
Provider Name (Legal Business Name): BABANDEEP KAUR SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 PARK ST
LENEXA KS
66215-3353
US

IV. Provider business mailing address

17386 W 158TH TER
OLATHE KS
66062-6760
US

V. Phone/Fax

Practice location:
  • Phone: 913-712-9680
  • Fax:
Mailing address:
  • Phone: 913-313-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-81997-062
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: