Healthcare Provider Details

I. General information

NPI: 1134493802
Provider Name (Legal Business Name): CHANDNI KAUR VIRDI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LILLY RD NE SUITE A
OLYMPIA WA
98506-5428
US

IV. Provider business mailing address

PO BOX 101299
PASADENA CA
91189-0005
US

V. Phone/Fax

Practice location:
  • Phone: 360-252-9777
  • Fax: 360-252-9778
Mailing address:
  • Phone: 206-805-8885
  • Fax: 206-522-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60266723
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP6026-6723
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: