Provider Demographics
NPI:1275896177
Name:KNIGHTON, ANN (RN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:KNIGHTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 W PORTNEUF RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-7331
Mailing Address - Country:US
Mailing Address - Phone:208-232-4998
Mailing Address - Fax:208-232-4998
Practice Address - Street 1:7050 W PORTNEUF RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-7331
Practice Address - Country:US
Practice Address - Phone:208-232-4998
Practice Address - Fax:208-232-4998
Is Sole Proprietor?:No
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-17658163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN-17658OtherIDAHO BOARD OF NURSING