1821501727 NPI number — DELPHINE ROSSI KNOWLTON MS, THD

Table of content: DELPHINE ROSSI KNOWLTON MS, THD (NPI 1821501727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821501727 NPI number — DELPHINE ROSSI KNOWLTON MS, THD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNOWLTON
Provider First Name:
DELPHINE
Provider Middle Name:
ROSSI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, THD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821501727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 376
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AFTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
83110-0376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-885-9883
Provider Business Mailing Address Fax Number:
307-885-5207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 376
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AFTON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
83110-0376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-885-9883
Provider Business Practice Location Address Fax Number:
307-885-5206
Provider Enumeration Date:
11/14/2017

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: 171M00000X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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