Provider Demographics
NPI:1528419884
Name:KNAPP, MIRANDA (MSN, RN, AGCNS)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:KNAPP
Suffix:
Gender:F
Credentials:MSN, RN, AGCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4969 SHANNON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-3381
Mailing Address - Country:US
Mailing Address - Phone:937-231-6105
Mailing Address - Fax:
Practice Address - Street 1:1810 SUCCESSFUL DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-9239
Practice Address - Country:US
Practice Address - Phone:937-231-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH396960163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice