Healthcare Provider Details

I. General information

NPI: 1114592623
Provider Name (Legal Business Name): GURSHARAN KAUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 HOSPITAL DR STE 200
SEDRO WOOLLEY WA
98284-9315
US

IV. Provider business mailing address

501 SOUTH WASHINGTON AVE.
SCRANTON PA
18505
US

V. Phone/Fax

Practice location:
  • Phone: 360-856-8800
  • Fax: 360-714-2520
Mailing address:
  • Phone: 570-591-5153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61488963
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: