MEDICARE: GLENDA ELAINE KNIGHT R.N.

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	163WG0100X	Gastroenterology Registered Nurse	4704096372	MI

General Provider Information

NPI Number	:	1932392958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA ELAINE KNIGHT R.N.

Provider Business Mailing Address
First Line	:	29556 TAWAS ST
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-5421
Country	:	US
Telephone Number	:	248-336-9517
Fax Number	:

Provider Business Practice Location Address
First Line	:	29556 TAWAS ST
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-5421
Country	:	US
Telephone Number	:	248-336-9517
Fax Number	:

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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