Provider Demographics
NPI:1336743020
Name:KNOPP, SUSAN DARLENE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DARLENE
Last Name:KNOPP
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 1:2792 EVANS RD
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:WV
Mailing Address - Zip Code:25123-6260
Mailing Address - Country:US
Mailing Address - Phone:304-674-9285
Mailing Address - Fax:
Practice Address - Street 1:2792 EVANS RD
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:WV
Practice Address - Zip Code:25123-6260
Practice Address - Country:US
Practice Address - Phone:304-674-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant