Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 71011224A | IN |
NPI | 1033783220 |
---|---|
Provider Name | Rebecca Knabenshue |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2021 |
Last Update Date | 02/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300051460 | (05) | IN |
M32727011 | MEDICARE PTAN (01) | IN |