Provider Demographics
NPI:1952610958
Name:KNOWLES, SUZETTE REGINA (LPN)
Entity type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:REGINA
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 N 67TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1109
Mailing Address - Country:US
Mailing Address - Phone:414-535-1778
Mailing Address - Fax:414-535-1778
Practice Address - Street 1:4208 N 67TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1109
Practice Address - Country:US
Practice Address - Phone:414-535-1778
Practice Address - Fax:414-535-1778
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32431164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse