Provider Demographics
NPI:1972964419
Name:KNOWLES, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16735 COUNTY ROAD 6
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4552
Mailing Address - Country:US
Mailing Address - Phone:507-400-2880
Mailing Address - Fax:507-540-0988
Practice Address - Street 1:318 CENTRAL AVE N
Practice Address - Street 2:LL 2
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5394
Practice Address - Country:US
Practice Address - Phone:507-400-2880
Practice Address - Fax:507-540-0988
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide