Healthcare Provider Details

I. General information

NPI: 1588528202
Provider Name (Legal Business Name): ANNETTE KNISLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 BROADWAY
SCOTTSBLUFF NE
69361-3167
US

IV. Provider business mailing address

540 19TH ST
GERING NE
69341-3916
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-2900
  • Fax:
Mailing address:
  • Phone: 308-635-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: