Provider Demographics
NPI:1861240624
Name:RANI, NONTOBEKO MANDISA
Entity type:Individual
Prefix:
First Name:NONTOBEKO
Middle Name:MANDISA
Last Name:RANI
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 1:336 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6633
Mailing Address - Country:US
Mailing Address - Phone:203-556-8987
Mailing Address - Fax:
Practice Address - Street 1:667 KINGSBOROUGH SQ STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4999
Practice Address - Country:US
Practice Address - Phone:757-436-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT146751163W00000X
NY759777163W00000X
DCRN500004485163W00000X
VA0001323953163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse