Healthcare Provider Details

I. General information

NPI: 1164495123
Provider Name (Legal Business Name): LAURIE A KNOKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CARI CT
DEKALB IL
60115-1014
US

IV. Provider business mailing address

2 CARI CT
DEKALB IL
60115-1014
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-2976
  • Fax:
Mailing address:
  • Phone: 815-758-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number20900572
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number041255075
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: