MEDICARE: MR. EDWARD HENRY KNIGHT LPN

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	164W00000X	Licensed Practical Nurse	LP042464	AZ

General Provider Information

NPI Number	:	1598091043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD HENRY KNIGHT LPN

Provider Business Mailing Address
First Line	:	4613 E ROBERT E LEE ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-9539
Country	:	US
Telephone Number	:	602-788-0451
Fax Number	:

Provider Business Practice Location Address
First Line	:	4613 E ROBERT E LEE ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-9539
Country	:	US
Telephone Number	:	602-788-0451
Fax Number	:

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

Provider Enumeration Date	:	10/18/2009
Last Update Date	:	11/28/2011

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