Provider Demographics
NPI:1679956486
Name:KNOKE, TERESA (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:KNOKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 MANOR PL
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4427
Mailing Address - Country:US
Mailing Address - Phone:920-883-8129
Mailing Address - Fax:
Practice Address - Street 1:964 MANOR PL
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4427
Practice Address - Country:US
Practice Address - Phone:920-883-8129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI222714163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse