Provider Demographics
NPI:1235674946
Name:KNAKE, SARAH (RN-CDE)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KNAKE
Suffix:
Gender:F
Credentials:RN-CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12928 SR 78
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-6861
Mailing Address - Country:US
Mailing Address - Phone:309-338-1897
Mailing Address - Fax:309-543-2089
Practice Address - Street 1:615 N PROMENADE ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-1243
Practice Address - Country:US
Practice Address - Phone:309-543-4431
Practice Address - Fax:309-543-2089
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041315180163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator