Provider Demographics
NPI:1235420258
Name:KNAPP, TAMRA R (LD)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:R
Last Name:KNAPP
Suffix:
Gender:F
Credentials:LD
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 860
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-0860
Mailing Address - Country:US
Mailing Address - Phone:207-873-9841
Mailing Address - Fax:207-873-9845
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5717
Practice Address - Country:US
Practice Address - Phone:207-626-1078
Practice Address - Fax:207-622-2398
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METD1075133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered