Basic Information
Provider Information | |||||||||
NPI: | 1528429826 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KNAPP | ||||||||
FirstName: | ALICIA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ENGLISH | ||||||||
OtherFirstName: | ALICIA | ||||||||
OtherMiddleName: | M | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 9040 REID STREET, ATTN: MCHJ-CLQ-C | ||||||||
Address2: | MADIGAN ARMY MEDICAL CENTER | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 984311000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2539681110 | ||||||||
FaxNumber: | 8778741031 | ||||||||
Practice Location | |||||||||
Address1: | 9040 REID STREET, ATTN: MCHJ-CLQ-C | ||||||||
Address2: | MADIGAN ARMY MEDICAL CENTER | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 984311000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2539681110 | ||||||||
FaxNumber: | 8778741031 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/14/2016 | ||||||||
LastUpdateDate: | 03/14/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146N00000X | E1891708 |   | Y |   | Emergency Medical Service Providers | Emergency Medical Technician, Basic |   |
No ID Information.