Provider Demographics
NPI:1376165779
Name:KNOUSE, ALLEGRIA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLEGRIA
Middle Name:ELIZABETH
Last Name:KNOUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 1/2 W BARRY AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1501
Mailing Address - Country:US
Mailing Address - Phone:814-722-4802
Mailing Address - Fax:
Practice Address - Street 1:1 CAMPUS RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4495
Practice Address - Country:US
Practice Address - Phone:718-420-4160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant