1316971328 NPI number — MRS. DANIELLE DENAE KNUTT RD LD

Table of content: MRS. DANIELLE DENAE KNUTT RD LD (NPI 1316971328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316971328 NPI number — MRS. DANIELLE DENAE KNUTT RD LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNUTT
Provider First Name:
DANIELLE
Provider Middle Name:
DENAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOHN
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
DENAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD LD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316971328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 BRENTWOOD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOGORDO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-437-3264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1402 INDIAN WELLS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-434-9764
Provider Business Practice Location Address Fax Number:
505-434-9768
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  LD0586 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05570280 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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