MEDICARE: LOUISE HENDERSHOTT KNOX ND, ARNP, MSN

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	163W00000X	Registered Nurse	RN267398	OH
2	363LF0000X	Family Nurse Practitioner	04255NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750374930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE HENDERSHOTT KNOX ND, ARNP, MSN

Provider Business Mailing Address
First Line	:	PO BOX 8792
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-8792
Country	:	US
Telephone Number	:	216-691-3102
Fax Number	:	216-691-3176

Provider Business Practice Location Address
First Line	:	4401 MAYFIELD RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-3609
Country	:	US
Telephone Number	:	216-691-3102
Fax Number	:	216-691-3176

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/02/2010

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