Provider Demographics
NPI:1669239547
Name:KNOBLAUCH, SUE ANN OKERWALL (RN)
Entity type:Individual
Prefix:
First Name:SUE ANN
Middle Name:OKERWALL
Last Name:KNOBLAUCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 PRAIRIEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-6627
Mailing Address - Country:US
Mailing Address - Phone:210-823-8360
Mailing Address - Fax:
Practice Address - Street 1:12337 JONES RD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4844
Practice Address - Country:US
Practice Address - Phone:121-082-3386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX560912163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management