Provider Demographics
NPI:1174646145
Name:GANGWAL, CHETNA (NP)
Entity type:Individual
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First Name:CHETNA
Middle Name:
Last Name:GANGWAL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:777 FLOWER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3015
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:818-242-8761
Practice Address - Street 1:2601 W ALAMEDA AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4800
Practice Address - Country:US
Practice Address - Phone:818-295-5920
Practice Address - Fax:818-295-6965
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP 16835363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner