Provider Demographics
NPI:1588680417
Name:KNIGHT, DEBRA ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANNE
Last Name:KNIGHT
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 1:47601 GRAND RIVER AVE
Mailing Address - Street 2:SUITE C104
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1233
Mailing Address - Country:US
Mailing Address - Phone:248-465-4777
Mailing Address - Fax:248-465-4843
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:SUITE C104
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-4777
Practice Address - Fax:248-465-4843
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002702363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S77234Medicare UPIN