MEDICARE: CHRISTINA KNOOP NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704270476	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4704270476	OTHER	MI	LARA - STATE OF MICHIGAN

General Provider Information

NPI Number	:	1346734910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA KNOOP NP

Provider Business Mailing Address
First Line	:	221 W LAKE LANSING RD STE 300
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8661
Country	:	US
Telephone Number	:	517-253-8944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 HYLAND DR
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-8508
Country	:	US
Telephone Number	:	517-647-6722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	10/23/2023

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Directions to “ CHRISTINA KNOOP NP” Practice Location

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