Healthcare Provider Details

I. General information

NPI: 1235674946
Provider Name (Legal Business Name): SARAH KNAKE RN-CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N PROMENADE ST
HAVANA IL
62644-1243
US

IV. Provider business mailing address

12928 SR 78
HAVANA IL
62644-6861
US

V. Phone/Fax

Practice location:
  • Phone: 309-543-4431
  • Fax: 309-543-2089
Mailing address:
  • Phone: 309-338-1897
  • Fax: 309-543-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number041315180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: