Provider Demographics
NPI:1003229576
Name:KNESEL, SHANA
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:KNESEL
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:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:OURAY
Mailing Address - State:CO
Mailing Address - Zip Code:81427-0670
Mailing Address - Country:US
Mailing Address - Phone:970-325-4670
Mailing Address - Fax:970-325-7314
Practice Address - Street 1:302 2ND STREET
Practice Address - Street 2:
Practice Address - City:OURAY
Practice Address - State:CO
Practice Address - Zip Code:81427-0670
Practice Address - Country:US
Practice Address - Phone:970-325-4670
Practice Address - Fax:970-325-7314
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1624624163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse