Provider Demographics
NPI:1093964678
Name:KNUTH, NANCY (CNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KNUTH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 BEAUBIEN ST
Mailing Address - Street 2:GENERAL PEDIATRIC CLINIC, SPECIALTY CENTER
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2120
Mailing Address - Country:US
Mailing Address - Phone:313-832-8270
Mailing Address - Fax:313-993-0081
Practice Address - Street 1:3950 BEAUBIEN ST
Practice Address - Street 2:GENERAL PEDIATRIC CLINIC, SPECIALTY CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2120
Practice Address - Country:US
Practice Address - Phone:313-832-8270
Practice Address - Fax:313-993-0081
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704258889363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics