Provider Demographics
NPI:1982349171
Name:KNAPP, TARA LYNN (STNA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:KNAPP
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:OH
Mailing Address - Zip Code:45122-9727
Mailing Address - Country:US
Mailing Address - Phone:513-465-1400
Mailing Address - Fax:
Practice Address - Street 1:1474 GIBSON RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-9727
Practice Address - Country:US
Practice Address - Phone:513-465-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602299111220376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide