Healthcare Provider Details

I. General information

NPI: 1356734172
Provider Name (Legal Business Name): ERICA JANE KNOERR F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5854 STATE ST
KINGSTON MI
48741-9524
US

IV. Provider business mailing address

4675 HILL ST
CASS CITY MI
48726-1008
US

V. Phone/Fax

Practice location:
  • Phone: 989-683-8065
  • Fax: 989-683-8088
Mailing address:
  • Phone: 989-683-8065
  • Fax: 989-683-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704257477
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: