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General NPI Number Information
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NPI Number | 1063214179
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Entity Type | Organization
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Legal Business Name | LIFESPARK HEALTH AND WELLNESS NURSING PC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 130 DIAMOND CREEK PL STE 100
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City | ROSEVILLE
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State | CA
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Zip | 95747-7592
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Country | US
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Telephone | 916-949-1258
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Fax |
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Provider Business Mailing Address
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Address Line | 1253 VISTA VERDE DR
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City | ROSEVILLE
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State | CA
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Zip | 95747-9656
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | RAMNEEK KAHLON
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Credential |
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Telephone | 916-949-1258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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