Provider Demographics
NPI:1952840241
Name:KNAAKE, ERIC (MSN, CRNP, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:KNAAKE
Suffix:
Gender:M
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 HANSHAW ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-273-6757
Mailing Address - Fax:607-273-2854
Practice Address - Street 1:8 BRENTWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1871
Practice Address - Country:US
Practice Address - Phone:607-277-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2019-04-02
Deactivation Date:2018-12-03
Deactivation Code:
Reactivation Date:2019-01-30
Provider Licenses
StateLicense IDTaxonomies
NYF343618-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN