Provider Demographics
NPI:1144963018
Name:CHAHAL, MANMEET KAUR
Entity type:Individual
Prefix:
First Name:MANMEET
Middle Name:KAUR
Last Name:CHAHAL
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 1:11603 W CALAVAR RD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-5097
Mailing Address - Country:US
Mailing Address - Phone:623-760-8928
Mailing Address - Fax:
Practice Address - Street 1:9128 N 64TH PL
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1841
Practice Address - Country:US
Practice Address - Phone:602-920-3318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN191797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN191797OtherARIZONA STATE BOARD OF NURSING