Provider Demographics
NPI:1124594015
Name:SANDHU, KAMALNEEL KAUR
Entity type:Individual
Prefix:
First Name:KAMALNEEL
Middle Name:KAUR
Last Name:SANDHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15125 MERIDIAN E STE 102
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:253-697-3066
Practice Address - Street 1:15125 MERIDIAN E STE 102
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6620
Practice Address - Country:US
Practice Address - Phone:253-697-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009495363LF0000X
WAAP61194166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily