Provider Demographics
NPI:1659416139
Name:KNOWLES, MICHELLE NANCY (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NANCY
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:NANCY
Other - Last Name:THIBAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:559 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1625
Mailing Address - Country:US
Mailing Address - Phone:508-339-2018
Mailing Address - Fax:
Practice Address - Street 1:52 2ND AVE
Practice Address - Street 2:SUITE 1110
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1127
Practice Address - Country:US
Practice Address - Phone:781-487-6100
Practice Address - Fax:781-487-6202
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228235363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health