Provider Demographics
NPI:1013665769
Name:GHALLEY, BIRKHA
Entity Type:Individual
Prefix:
First Name:BIRKHA
Middle Name:
Last Name:GHALLEY
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 1:704 23RD ST S APT 20
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2493
Mailing Address - Country:US
Mailing Address - Phone:701-951-9114
Mailing Address - Fax:
Practice Address - Street 1:704 23RD ST S APT 20
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2493
Practice Address - Country:US
Practice Address - Phone:701-526-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant