Provider Demographics
NPI:1114632296
Name:RAI, INDRA MAYA
Entity Type:Individual
Prefix:
First Name:INDRA
Middle Name:MAYA
Last Name:RAI
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 1:1102 22ND ST S APT 301
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2980
Mailing Address - Country:US
Mailing Address - Phone:701-630-5788
Mailing Address - Fax:
Practice Address - Street 1:1102 22ND ST S APT 301
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2980
Practice Address - Country:US
Practice Address - Phone:701-630-5788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide