Provider Demographics
NPI:1508675331
Name:KNAPP, JENNIE CLARICE
Entity type:Individual
Prefix:MISS
First Name:JENNIE
Middle Name:CLARICE
Last Name:KNAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JENNIE
Other - Middle Name:CLARICE
Other - Last Name:HAVERLUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2536 CARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1221
Mailing Address - Country:US
Mailing Address - Phone:308-385-5775
Mailing Address - Fax:308-385-5780
Practice Address - Street 1:709 E 11TH ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-2603
Practice Address - Country:US
Practice Address - Phone:308-385-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion