Provider Demographics
NPI:1417285933
Name:MCKNIGHT, FERN ILENE (LPN)
Entity Type:Individual
Prefix:MS
First Name:FERN
Middle Name:ILENE
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:FERN
Other - Middle Name:ILENE
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:17458 WEST SHEDD ROAD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85193
Mailing Address - Country:US
Mailing Address - Phone:520-560-2160
Mailing Address - Fax:
Practice Address - Street 1:17458 WEST SHEDD ROAD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85193
Practice Address - Country:US
Practice Address - Phone:520-560-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP034704164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse