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General NPI Number Information
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NPI Number | 1972551497
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Entity Type | Individual
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Provider Name | GWENDOLYN K KNOTTS
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7675 STERLING AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-4738
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Country | US
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Telephone | 909-381-8983
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Fax | 909-381-2933
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Provider Business Mailing Address
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Address Line | 742 W HIGHLAND AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92405-3839
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Country | US
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Telephone | 909-881-7320
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Fax | 909-881-7330
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | RN250278
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License Number State | CA
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