Change of Name/Address Form - ND Nurse Aide Registry

Nurse Aide Registry Online Services
Emergency Activation
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Change Address/Name

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Last Name	Last 4 of SSN	Registrant ID #

For more information, contact the NA Registry at naregistry@nd.gov.

600 E. Boulevard Ave., Dept. 301
Bismarck N.D. 58505-0200
Phone: 701.328.2353 Fax: 701.328.1890