Provider Demographics
NPI:1366470817
Name:KNAPPER, CONNIE D (CNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:D
Last Name:KNAPPER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-9289
Mailing Address - Country:US
Mailing Address - Phone:989-539-6421
Mailing Address - Fax:989-539-1180
Practice Address - Street 1:741 RICHARD DR
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-9289
Practice Address - Country:US
Practice Address - Phone:989-539-6421
Practice Address - Fax:989-539-1180
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704140084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4426910Medicaid
R77059Medicare UPIN
MI4426910Medicaid