Provider Demographics
NPI:1871218685
Name:RANDHAWA, RAMANDEEP KAUR (NP)
Entity type:Individual
Prefix:
First Name:RAMANDEEP
Middle Name:KAUR
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3745
Mailing Address - Country:US
Mailing Address - Phone:209-825-5155
Mailing Address - Fax:
Practice Address - Street 1:1040 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-3745
Practice Address - Country:US
Practice Address - Phone:209-825-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily