Provider Demographics
NPI:1407288483
Name:SANDHU, JAGJIT SINGH (CRNA)
Entity type:Individual
Prefix:
First Name:JAGJIT
Middle Name:SINGH
Last Name:SANDHU
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7445 102ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8446
Mailing Address - Country:US
Mailing Address - Phone:928-533-7234
Mailing Address - Fax:
Practice Address - Street 1:815 AINSWORTH DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1631
Practice Address - Country:US
Practice Address - Phone:928-533-7234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0970367500000X
AZRN144443367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered