Basic Information
Provider Information
NPI: 1174924039
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KNABE
FirstName: FRANK
MiddleName: DARREL
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3622 E SAN CARLOS PL
Address2:  
City: CHANDLER
State: AZ
PostalCode: 852492027
CountryCode: US
TelephoneNumber: 4803903026
FaxNumber:  
Practice Location
Address1: 1955 W FRYE RD
Address2:  
City: CHANDLER
State: AZ
PostalCode: 852246282
CountryCode: US
TelephoneNumber: 4807283753
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/10/2014
LastUpdateDate: 09/10/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X5796AZY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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