MEDICARE: BRIDGETTE MARIE KNOWER CCP, MHA

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	242T00000X	Perfusionist	PEF.200059	LA

General Provider Information

NPI Number	:	1891658225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETTE MARIE KNOWER CCP, MHA

Provider Business Mailing Address
First Line	:	3004 SAINT RENE ST
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-4231
Country	:	US
Telephone Number	:	504-723-6207
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 SAINT RENE ST
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-4231
Country	:	US
Telephone Number	:	504-723-6207
Fax Number	:

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

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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