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NPI Code Detail

MEDICARE: MR. KENDALL BRENNAN KNOBELOCH RN

MEDICARE: MR. KENDALL BRENNAN KNOBELOCH RN
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
1163W00000XRegistered Nurse041433013IL
2163W00000XRegistered Nurse2015031592MO

General Provider Information

NPI Number : 1952831893
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENDALL BRENNAN KNOBELOCH RN
Provider Business Mailing Address
First Line : 2300 WOODLAWN AVE
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-4035
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2100 MADISON AVE
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-4713
Country : US
Telephone Number : 618-798-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2017
Last Update Date : 12/11/2019

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