Provider Demographics
NPI:1043505118
Name:KHALSA, ATMA KAUR (RN)
Entity type:Individual
Prefix:MRS
First Name:ATMA
Middle Name:KAUR
Last Name:KHALSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:MARY
Other - Last Name:HOGAMIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38207 CALLE CIPRES
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9348
Mailing Address - Country:US
Mailing Address - Phone:951-698-9422
Mailing Address - Fax:951-240-3405
Practice Address - Street 1:38207 CALLE CIPRES
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9348
Practice Address - Country:US
Practice Address - Phone:951-698-9422
Practice Address - Fax:951-240-3405
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255658164X00000X
CA847629163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse