Provider Demographics
NPI:1306482831
Name:CHAHAL, GURPAL SINGH
Entity type:Individual
Prefix:
First Name:GURPAL
Middle Name:SINGH
Last Name:CHAHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98231-0959
Mailing Address - Country:US
Mailing Address - Phone:360-207-1613
Mailing Address - Fax:
Practice Address - Street 1:1155 N STATE ST STE 522
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5045
Practice Address - Country:US
Practice Address - Phone:360-676-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998282-NP363LP0808X
390200000X
WARN60793386163W00000X
WAAP61196426363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse