Provider Demographics
NPI:1306738539
Name:RAI, NISHA N (PREVIOUS CNA)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:N
Last Name:RAI
Suffix:
Gender:F
Credentials:PREVIOUS CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 23RD ST S APT 301
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2977
Mailing Address - Country:US
Mailing Address - Phone:701-219-3536
Mailing Address - Fax:701-219-3536
Practice Address - Street 1:1010 23RD ST S APT 301
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2977
Practice Address - Country:US
Practice Address - Phone:701-219-3536
Practice Address - Fax:701-219-3536
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRAI-01-85533747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant