Provider Demographics
NPI:1760085377
Name:GHALEY, MADAN MAYA I
Entity Type:Individual
Prefix:
First Name:MADAN
Middle Name:MAYA
Last Name:GHALEY
Suffix:I
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 1:2392 STAR AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3475
Mailing Address - Country:US
Mailing Address - Phone:701-739-8966
Mailing Address - Fax:
Practice Address - Street 1:2392 STAR AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3475
Practice Address - Country:US
Practice Address - Phone:701-739-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant