Provider Demographics
NPI:1265169536
Name:KHANYILE, MUSA MBALI (RN492200)
Entity type:Individual
Prefix:
First Name:MUSA
Middle Name:MBALI
Last Name:KHANYILE
Suffix:
Gender:F
Credentials:RN492200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 EDINBORO CT APT A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1168
Mailing Address - Country:US
Mailing Address - Phone:937-977-5613
Mailing Address - Fax:
Practice Address - Street 1:834 EDINBORO CT APT A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-1168
Practice Address - Country:US
Practice Address - Phone:937-977-5613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.492200163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health