Provider Demographics
NPI:1851163497
Name:KHONDE, EDNOCK NTUNGUMU
Entity Type:Individual
Prefix:
First Name:EDNOCK
Middle Name:NTUNGUMU
Last Name:KHONDE
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 1:10 COLUMBIA ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-4802
Mailing Address - Country:US
Mailing Address - Phone:207-352-8862
Mailing Address - Fax:
Practice Address - Street 1:10 COLUMBIA ST UNIT 2
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-4802
Practice Address - Country:US
Practice Address - Phone:207-352-8862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health