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General NPI Number Information
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NPI Number | 1184469777
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Entity Type | Individual
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Provider Name | NATHANIEL KNOLL PMHNP - BC
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Gender | Male
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Dates
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Enumeration Date | 06/26/2024
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 3081 TEAGARDEN ST
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City | SAN LEANDRO
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State | CA
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Zip | 94577-5720
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Country | US
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Telephone | 510-347-9457
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Fax | 510-686-8806
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Provider Business Mailing Address
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Address Line | 3081 TEAGARDEN ST
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City | SAN LEANDRO
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State | CA
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Zip | 94577-5720
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Country | US
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Telephone | 510-347-4620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95030772
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License Number State | CA
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