Provider Demographics
NPI:1669404562
Name:KNOWLES, ANN M (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:M
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-339-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA080148615OtherRAILROAD MEDICARE
WA8924384OtherL&I CRIME VICTIM
WA423898049OtherGROUP HEALTH COOPERATIVE
WA67444OtherREGENCE BLUESHIELD
WA8223919Medicaid
WA0131540OtherL&I REGULAR
WAGAB11106Medicare PIN
WA0131540OtherL&I REGULAR