Provider Demographics
NPI:1700180783
Name:KNUTH, NICOLE LEIGH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEIGH
Last Name:KNUTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:LEIGH
Other - Last Name:THORNBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8663
Mailing Address - Fax:304-234-8960
Practice Address - Street 1:515 MERIDAN ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2317
Practice Address - Country:US
Practice Address - Phone:304-234-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV70178367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered