Individual
MR. EDWIN CHARLES KHONYONGWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LALFA, LPN
Contact information
Practice address
7829 DOLLEYS CT, KING GEORGE, VA 22485-7085
(540) 318-3940
(703) 910-6907
Mailing address
5153 SPINNAKER LN, KING GEORGE, VA 22485-3163
(571) 354-9781
(703) 910-6907
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002092297
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002092297
LICENSED PRACTICAL NURSE
VA
01
—
1401150271
NURSE AID
VA
01
—
1706001017
ASSISTED LIVING ADMINISTRATOR
VA
01
—
1732000897
NURSING HOME ADMINISTRATOR
VA
Enumeration date
08/28/2020
Last updated
08/28/2020
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