Provider Demographics
NPI:1578542890
Name:KNORR, JOHN LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEE
Last Name:KNORR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3038
Mailing Address - Country:US
Mailing Address - Phone:712-792-3581
Mailing Address - Fax:712-792-2124
Practice Address - Street 1:311 S CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3038
Practice Address - Country:US
Practice Address - Phone:712-792-3581
Practice Address - Fax:712-792-2124
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073443367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0123406Medicaid
IA26786Medicare ID - Type Unspecified