Healthcare Provider Details

I. General information

NPI: 1134142276
Provider Name (Legal Business Name): ERIN BETH KNOWLTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COMMERCE LANE
CANTON NY
13617
US

IV. Provider business mailing address

704 SOUTH CANTON ROAD
POTSDAM NY
13676
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-8191
  • Fax: 315-386-1410
Mailing address:
  • Phone: 315-386-8191
  • Fax: 315-386-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number456910
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: