Provider Demographics
NPI:1962496422
Name:KNAUR, SANDRA L (RN, CANP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:KNAUR
Suffix:
Gender:F
Credentials:RN, CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 OMEGA DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2075
Mailing Address - Country:US
Mailing Address - Phone:817-465-5881
Mailing Address - Fax:817-465-6336
Practice Address - Street 1:1521 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2711
Practice Address - Country:US
Practice Address - Phone:817-336-5864
Practice Address - Fax:817-336-2159
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81N350Medicare PIN
TXS54973Medicare UPIN
TX039578201Medicaid