MEDICARE: VANESSA KNOWLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	0244983	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467104646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA KNOWLES

Provider Business Mailing Address
First Line	:	4806 BURGER AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5328
Country	:	US
Telephone Number	:	216-682-9718
Fax Number	:

Provider Business Practice Location Address
First Line	:	4806 BURGER AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5328
Country	:	US
Telephone Number	:	216-682-9718
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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Directions to “ VANESSA KNOWLES ” Practice Location

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