Provider Demographics
NPI:1205025715
Name:KNOPP, ETHEL MARIE (RN, LMP)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:MARIE
Last Name:KNOPP
Suffix:
Gender:F
Credentials:RN, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3027
Mailing Address - Country:US
Mailing Address - Phone:509-783-0281
Mailing Address - Fax:
Practice Address - Street 1:317 N UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3027
Practice Address - Country:US
Practice Address - Phone:509-783-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00078529163WM1400X
WAMA00005519225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)