Healthcare Provider Details

I. General information

NPI: 1912371907
Provider Name (Legal Business Name): ALBINA KNIGHT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALBINA KNIGHT

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 W LIBERTY ST
WAUCONDA IL
60084-2452
US

IV. Provider business mailing address

PO BOX 6037
WAUCONDA IL
60084-6037
US

V. Phone/Fax

Practice location:
  • Phone: 847-526-2151
  • Fax: 847-526-2017
Mailing address:
  • Phone: 847-526-2151
  • Fax: 847-526-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.013565
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.013565
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: