Basic Information
Provider Information
NPI: 1003002304
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KNAPP
FirstName: RACHEL
MiddleName: LOUISE
NamePrefix: MISS
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 27885 170TH AVE SW
Address2:  
City: CROOKSTON
State: MN
PostalCode: 567169444
CountryCode: US
TelephoneNumber: 2182813506
FaxNumber: 2182813015
Practice Location
Address1: 27885 170TH AVE SW
Address2:  
City: CROOKSTON
State: MN
PostalCode: 567169444
CountryCode: US
TelephoneNumber: 2182813506
FaxNumber: 2182813015
Other Information
ProviderEnumerationDate: 09/20/2007
LastUpdateDate: 09/20/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
3747P1801X  Y Nursing Service Related ProvidersTechnicianPersonal Care Attendant

No ID Information.


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