Provider Demographics
NPI:1184740060
Name:KNATZ, ANDREA MICHELLE (LD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:KNATZ
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:KNATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:10700 PINON PARK CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5162
Mailing Address - Country:US
Mailing Address - Phone:505-918-9334
Mailing Address - Fax:
Practice Address - Street 1:10700 PINON PARK CT NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5162
Practice Address - Country:US
Practice Address - Phone:505-918-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0795133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered