Provider Demographics
NPI:1770185639
Name:GHIMIRE, TEJ B
Entity Type:Individual
Prefix:
First Name:TEJ
Middle Name:B
Last Name:GHIMIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 29TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3158
Mailing Address - Country:US
Mailing Address - Phone:701-200-7477
Mailing Address - Fax:
Practice Address - Street 1:2220 6TH AVE S APT 61
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2455
Practice Address - Country:US
Practice Address - Phone:701-200-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant