Provider Demographics
NPI:1245612910
Name:KNOPP, AMANDA (CNA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:KNOPP
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 KELLER LOOP
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-9394
Mailing Address - Country:US
Mailing Address - Phone:570-492-6398
Mailing Address - Fax:
Practice Address - Street 1:539 KELLER LOOP
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-9394
Practice Address - Country:US
Practice Address - Phone:570-492-6398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAT1512641004251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4352743OtherENTITY NUMBER