Knackstedt, Shirley
Knackstedt, Shirley is an individual health care provider with primary practice located at 7218 4Th St Nw , Los Ranchos NM 87107-6624. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Knackstedt, Shirley can be contacted via phone (505) 730-5603.Contact Information
Primary practice address
7218 4Th St Nw
Los Ranchos NM 87107-6624
Phone: (505) 730-5603
Fax: (505) 554-2313
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | R39671/CNP00873 | New Mexico |
Profile Details
| NPI number | 1114908761 |
|---|---|
| LBN Legal business name | Knackstedt, Shirley |
| Credentials | Certified Family Nurse Practitioner (CFNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 10th, 2005 |
| Last updated | Apr 4th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114908761 | NPPES |
| New Mexico | MEDICAID | K3771 |
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