MEDICARE: TINA L KNOUSE RN, TXLAC

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	171100000X	Acupuncturist	AC00911	TX

General Provider Information

NPI Number	:	1710170337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA L KNOUSE RN, TXLAC

Provider Business Mailing Address
First Line	:	3352 BROADWAY BLVD
Second Line	:	#393
City	:	GARLAND
State	:	TX
Zip	:	75043-1531
Country	:	US
Telephone Number	:	214-406-2210
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 W I 30
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-5912
Country	:	US
Telephone Number	:	214-406-2210
Fax Number	:

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

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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