Provider Demographics
NPI:1750374930
Name:KNOX, LOUISE HENDERSHOTT (ND, ARNP, MSN)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:HENDERSHOTT
Last Name:KNOX
Suffix:
Gender:F
Credentials:ND, ARNP, MSN
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 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:216-691-3102
Mailing Address - Fax:216-691-3176
Practice Address - Street 1:4401 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3609
Practice Address - Country:US
Practice Address - Phone:216-691-3102
Practice Address - Fax:216-691-3176
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN267398163W00000X
OH04255NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2211298Medicaid
OH2211298Medicaid