Healthcare Provider Details

I. General information

NPI: 1346734910
Provider Name (Legal Business Name): CHRISTINA KNOOP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 HYLAND DR
PORTLAND MI
48875-8508
US

IV. Provider business mailing address

221 W LAKE LANSING RD STE 300
EAST LANSING MI
48823-8661
US

V. Phone/Fax

Practice location:
  • Phone: 517-647-6722
  • Fax:
Mailing address:
  • Phone: 517-253-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704270476
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: