Provider Demographics
NPI:1154047181
Name:UPPAL, GAVNEET (FNP-C)
Entity type:Individual
Prefix:
First Name:GAVNEET
Middle Name:
Last Name:UPPAL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 AMERICAN AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-3268
Mailing Address - Country:US
Mailing Address - Phone:317-410-1131
Mailing Address - Fax:
Practice Address - Street 1:4577 LA JOLLA VILLAGE DR STE 1212
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1494
Practice Address - Country:US
Practice Address - Phone:619-894-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28244838A163W00000X
CA95374146163W00000X
IN71013180A363LF0000X
CA95030427363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily