Provider Demographics
NPI:1265180582
Name:NKULU KASONGO WA NDAY, RAISSA (PA-C)
Entity type:Individual
Prefix:
First Name:RAISSA
Middle Name:
Last Name:NKULU KASONGO WA NDAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5308
Mailing Address - Country:US
Mailing Address - Phone:413-442-8267
Mailing Address - Fax:
Practice Address - Street 1:426 EAST ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5308
Practice Address - Country:US
Practice Address - Phone:413-442-8267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant