Provider Demographics
NPI:1053696591
Name:KNOWLTON, JOANNE BARBARA (RN)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:BARBARA
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6485 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17320-9617
Mailing Address - Country:US
Mailing Address - Phone:717-642-1547
Mailing Address - Fax:717-642-1547
Practice Address - Street 1:6485 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:PA
Practice Address - Zip Code:17320-9617
Practice Address - Country:US
Practice Address - Phone:717-642-1547
Practice Address - Fax:717-642-1547
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR101581163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse