Provider Demographics
NPI:1417149675
Name:KNAPKE, ANDREA E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:E
Last Name:KNAPKE
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 1:1050 EAST GREENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2622
Mailing Address - Country:US
Mailing Address - Phone:419-394-3331
Mailing Address - Fax:
Practice Address - Street 1:1165 S KNOXVILLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2622
Practice Address - Country:US
Practice Address - Phone:419-394-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002634363AS0400X, 363A00000X
IL085003591363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091238Medicaid
OHH198891Medicare PIN
OH9264083Medicare PIN