Healthcare Provider Details

I. General information

NPI: 1831486786
Provider Name (Legal Business Name): DAVID JOHN KNIOLA CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN ROAD EAST MAIL ROUTE MN 008-8213
MINNETONKA MN
55343
US

IV. Provider business mailing address

795 WOODS FERRY RD
LINCOLN AL
35096-5873
US

V. Phone/Fax

Practice location:
  • Phone: 866-799-5886
  • Fax:
Mailing address:
  • Phone: 256-375-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-068065
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: