Provider Demographics
NPI:1922015098
Name:KNAPP, RENDA K (MD)
Entity Type:Individual
Prefix:MRS
First Name:RENDA
Middle Name:K
Last Name:KNAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 BARTLETT STREET
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7001
Mailing Address - Country:US
Mailing Address - Phone:907-235-8586
Mailing Address - Fax:907-235-6639
Practice Address - Street 1:4136 BARTLETT STREET
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7001
Practice Address - Country:US
Practice Address - Phone:907-235-8586
Practice Address - Fax:907-235-6639
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK103505207V00000X
VA01012386797207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1523700Medicaid
VA1922015098Medicaid
H17465Medicare UPIN
TN103I163788Medicare PIN