Provider Demographics
NPI:1447872965
Name:DHALIWAL, GAGAN PREET KAUR (MSN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:GAGAN PREET
Middle Name:KAUR
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:MSN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45418 GLENGARRY BLVD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3001
Mailing Address - Country:US
Mailing Address - Phone:734-837-3074
Mailing Address - Fax:
Practice Address - Street 1:45418 GLENGARRY BLVD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-3001
Practice Address - Country:US
Practice Address - Phone:734-837-3074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311497363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care