Provider Demographics
NPI:1891816187
Name:KNOWLTON, CHRISTINA M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:M
Last Name:KNOWLTON
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 1:950 RINARD MILLS RD
Mailing Address - Street 2:
Mailing Address - City:NEW MATAMORAS
Mailing Address - State:OH
Mailing Address - Zip Code:45767-7010
Mailing Address - Country:US
Mailing Address - Phone:740-865-2169
Mailing Address - Fax:740-865-2169
Practice Address - Street 1:950 RINARD MILLS RD
Practice Address - Street 2:
Practice Address - City:NEW MATAMORAS
Practice Address - State:OH
Practice Address - Zip Code:45767-7010
Practice Address - Country:US
Practice Address - Phone:740-865-2169
Practice Address - Fax:740-865-2169
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN101442164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2694606Medicaid