Provider Demographics
NPI:1154869956
Name:DHALIWAL, SUKHDEEP KAUR (RN,BSN)
Entity type:Individual
Prefix:
First Name:SUKHDEEP
Middle Name:KAUR
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 RED RIBBONS LN
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7926
Mailing Address - Country:US
Mailing Address - Phone:510-600-1440
Mailing Address - Fax:
Practice Address - Street 1:1538 RED RIBBONS LN
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7926
Practice Address - Country:US
Practice Address - Phone:510-600-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024019163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse