Provider Demographics
NPI:1982485215
Name:KNOLLMAN, ALICIA (RN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:KNOLLMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5778 STATE ROUTE 350
Mailing Address - Street 2:
Mailing Address - City:OREGONIA
Mailing Address - State:OH
Mailing Address - Zip Code:45054-9760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5778 STATE ROUTE 350
Practice Address - Street 2:
Practice Address - City:OREGONIA
Practice Address - State:OH
Practice Address - Zip Code:45054-9760
Practice Address - Country:US
Practice Address - Phone:513-800-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.381647163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse