Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 209001792 | IL |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 3270033 | WI |
NPI | 1063607778 |
---|---|
Provider Name | Kristina Knight |
First Address | Wausau, WI 54401-2965 |
Second Address | Wausau, WI 54401-2965 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 01/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P88976 | (02) |