Provider Demographics
NPI:1659956902
Name:KHADONDI, IRENE (LPN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:KHADONDI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 POMEWORTH ST APT 46
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1269
Mailing Address - Country:US
Mailing Address - Phone:978-996-2526
Mailing Address - Fax:
Practice Address - Street 1:30 POMEWORTH ST APT 46
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1269
Practice Address - Country:US
Practice Address - Phone:978-996-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA91199164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse