Provider Demographics
NPI:1194416198
Name:GHONGKEDZE, ELENA (RN)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:GHONGKEDZE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 489 BOX 1449
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09751-0015
Mailing Address - Country:US
Mailing Address - Phone:703-606-6245
Mailing Address - Fax:
Practice Address - Street 1:U.S. ARMY HEALTH CLINIC STUTTGART
Practice Address - Street 2:UNIT 30401 PATCH BARRACKS, GERMANY
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09107
Practice Address - Country:US
Practice Address - Phone:314-430-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001280905163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse