Provider Demographics
NPI:1689237109
Name:KNOWLES, BIENVENUE MEGNE (APRN)
Entity Type:Individual
Prefix:
First Name:BIENVENUE
Middle Name:MEGNE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5407
Mailing Address - Country:US
Mailing Address - Phone:512-554-4942
Mailing Address - Fax:
Practice Address - Street 1:2025 E 71ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5407
Practice Address - Country:US
Practice Address - Phone:512-554-4942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK107593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily