Provider Demographics
NPI:1649062639
Name:GHALEY, JON
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:GHALEY
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 1:3160 33RD ST S APT 208
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7837
Mailing Address - Country:US
Mailing Address - Phone:701-730-7385
Mailing Address - Fax:
Practice Address - Street 1:2596 FULTON LOOP S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-2901
Practice Address - Country:US
Practice Address - Phone:701-306-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant