Healthcare Provider Details

I. General information

NPI: 1154957306
Provider Name (Legal Business Name): NICOLE KNOWLES CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 GASTON AVE
DALLAS TX
75246-1014
US

IV. Provider business mailing address

1801 ANNEX AVE UNIT 501
DALLAS TX
75204-4660
US

V. Phone/Fax

Practice location:
  • Phone: 817-733-3018
  • Fax:
Mailing address:
  • Phone: 817-733-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: