Provider Demographics
NPI:1063214179
Name:LIFESPARK HEALTH AND WELLNESS NURSING PC
Entity type:Organization
Organization Name:LIFESPARK HEALTH AND WELLNESS NURSING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAMNEEK
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-949-1258
Mailing Address - Street 1:1253 VISTA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 DIAMOND CREEK PL STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7592
Practice Address - Country:US
Practice Address - Phone:916-949-1258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty