MEDICARE: SUE ANN OKERWALL KNOBLAUCH RN

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	163WC0400X	Case Management Registered Nurse	560912	TX

General Provider Information

NPI Number	:	1669239547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE ANN OKERWALL KNOBLAUCH RN

Provider Business Mailing Address
First Line	:	206 PRAIRIEDALE AVE
Second Line	:
City	:	VILLE PLATTE
State	:	LA
Zip	:	70586-6627
Country	:	US
Telephone Number	:	210-823-8360
Fax Number	:

Provider Business Practice Location Address
First Line	:	12337 JONES RD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4844
Country	:	US
Telephone Number	:	121-082-3386
Fax Number	:

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

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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