Provider Demographics
NPI:1548014384
Name:KHAND THAKURI, SANAM (FNP)
Entity type:Individual
Prefix:
First Name:SANAM
Middle Name:
Last Name:KHAND THAKURI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 LANDAU RD
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-4579
Mailing Address - Country:US
Mailing Address - Phone:443-714-0343
Mailing Address - Fax:
Practice Address - Street 1:9705 NORTHEAST PKWY STE 400
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9704
Practice Address - Country:US
Practice Address - Phone:704-844-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024000311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily