Provider Demographics
NPI:1184481640
Name:KNOX, AMY LUNA (CNS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LUNA
Last Name:KNOX
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 LINCOLN TRAIL
Mailing Address - Street 2:STE 16, #248
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208
Mailing Address - Country:US
Mailing Address - Phone:615-579-2435
Mailing Address - Fax:
Practice Address - Street 1:10850 LINCOLN TRAIL
Practice Address - Street 2:STE 16, #248
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208
Practice Address - Country:US
Practice Address - Phone:615-579-2435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007681133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist