Provider Demographics
NPI:1881222578
Name:KNUCKLES, DARLENDA (LPN)
Entity Type:Individual
Prefix:
First Name:DARLENDA
Middle Name:
Last Name:KNUCKLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:DARLENDA
Other - Middle Name:
Other - Last Name:KNUCKLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:43825 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43825 MICHIGAN AVE, CANTON, MI 48188
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188
Practice Address - Country:US
Practice Address - Phone:734-224-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703118822164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse