Provider Demographics
NPI:1356042493
Name:KNOWLTON, LEAH ELAINE (LPN)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:ELAINE
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13832 S ALEXIS CIR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-3939
Mailing Address - Country:US
Mailing Address - Phone:385-225-1475
Mailing Address - Fax:
Practice Address - Street 1:6700 I-10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201
Practice Address - Country:US
Practice Address - Phone:210-736-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12386020-3101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse