Provider Demographics
NPI:1184211302
Name:KNUCKLES, ARLENE (RN)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:KNUCKLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 W ERVIN RD
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2201
Mailing Address - Country:US
Mailing Address - Phone:260-710-2558
Mailing Address - Fax:
Practice Address - Street 1:703 W ERVIN RD
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2201
Practice Address - Country:US
Practice Address - Phone:260-710-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH.359944163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse