Provider Demographics
NPI:1710877873
Name:GREWAL, HARSIMRAN KAUR
Entity type:Individual
Prefix:
First Name:HARSIMRAN
Middle Name:KAUR
Last Name:GREWAL
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 1:2243 NISPEROS ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6131
Mailing Address - Country:US
Mailing Address - Phone:209-993-8812
Mailing Address - Fax:
Practice Address - Street 1:7236 S RECOVERY RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-8901
Practice Address - Country:US
Practice Address - Phone:209-888-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA746151164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse