Provider Demographics
NPI:1801495437
Name:CADE, MANDISHA CAISHA
Entity type:Individual
Prefix:
First Name:MANDISHA
Middle Name:CAISHA
Last Name:CADE
Suffix:
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 1:1101 WESTWOOD ST APT 115
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6289
Mailing Address - Country:US
Mailing Address - Phone:701-805-1005
Mailing Address - Fax:
Practice Address - Street 1:1101 WESTWOOD ST APT 115
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6289
Practice Address - Country:US
Practice Address - Phone:701-805-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant