Provider Demographics
NPI:1851883177
Name:KNIESS, JUAHARA (LPN)
Entity Type:Individual
Prefix:MS
First Name:JUAHARA
Middle Name:
Last Name:KNIESS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6169 GREENFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1318
Mailing Address - Country:US
Mailing Address - Phone:937-818-8233
Mailing Address - Fax:
Practice Address - Street 1:4950 NORTHCUTT PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3840
Practice Address - Country:US
Practice Address - Phone:937-496-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-086-307-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse