Healthcare Provider Details

I. General information

NPI: 1538808035
Provider Name (Legal Business Name): NIKITA GANDHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10596 HALSTEAD CR
WINDSOR ONTARIO
N8R 2C4
CA

IV. Provider business mailing address

10596 HALSTEAD CR
WINDSOR ONTARIO
N8R 2C4
CA

V. Phone/Fax

Practice location:
  • Phone: 519-991-3136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704323373
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: