Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 12267 | NV |
NPI | 1073705273 |
---|---|
Provider Name | Dr. Stacey Blair Knobler |
First Address | Reno, NV 89509-6164 |
Second Address | Reno, NV 89509-6164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 11/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G45950 | (02) |