Provider Demographics
NPI:1982849972
Name:KNACKSTEDT, AMI M (RN, CDE)
Entity Type:Individual
Prefix:MS
First Name:AMI
Middle Name:M
Last Name:KNACKSTEDT
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 SE HAWTHORNE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8198
Mailing Address - Country:US
Mailing Address - Phone:515-360-0863
Mailing Address - Fax:515-987-6659
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:515-241-5926
Practice Address - Fax:515-241-5927
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096743163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator