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General NPI Number Information
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NPI Number | 1225410830
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Entity Type | Organization
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Legal Business Name | KNOWLTON FAMILY PRACTICE
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 06/19/2015
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Provider Practice Location Address
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Address Line | 1001 PIKE ST 7A
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City | MARIETTA
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State | OH
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Zip | 45750-3515
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Country | US
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Telephone | 740-629-8528
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 PIKE ST 7A
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City | MARIETTA
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State | OH
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Zip | 45750-3515
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Country | US
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Telephone | 740-629-8528
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | LESLY KNOWLTON
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Credential | NP
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Telephone | 740-629-8528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | NP08402
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License Number State | OH
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