Provider Demographics
NPI:1023541075
Name:KNOTWELL, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KNOTWELL
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 1:218 BRIDGE AVE
Mailing Address - Street 2:218 BRIDGE AVENUE
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-1006
Mailing Address - Country:US
Mailing Address - Phone:570-286-4982
Mailing Address - Fax:570-286-4984
Practice Address - Street 1:218 BRIDGE AVE
Practice Address - Street 2:218 BRIDGE AVENUE
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-1006
Practice Address - Country:US
Practice Address - Phone:570-286-4982
Practice Address - Fax:570-286-4984
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN291970164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101490123Medicaid