Provider Demographics
NPI:1275350894
Name:RAGE, SHAMSO OSMAN
Entity type:Individual
Prefix:
First Name:SHAMSO
Middle Name:OSMAN
Last Name:RAGE
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 1:211 2ND AVE SW APT 202
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4150
Mailing Address - Country:US
Mailing Address - Phone:860-997-3086
Mailing Address - Fax:
Practice Address - Street 1:211 2ND AVE SW APT 202
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4150
Practice Address - Country:US
Practice Address - Phone:860-997-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND145446251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care