Provider Demographics
NPI:1164495123
Name:KNOKE, LAURIE A (NP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:KNOKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CARI CT
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-1014
Mailing Address - Country:US
Mailing Address - Phone:815-758-2976
Mailing Address - Fax:
Practice Address - Street 1:2 CARI CT
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-1014
Practice Address - Country:US
Practice Address - Phone:815-758-2976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20900572363LX0001X
IL041255075363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212788001Medicare PIN
ILF400097752Medicare PIN
ILP07867Medicare UPIN
ILF400097851Medicare PIN