Basic Information
| Provider Information | |||||||||
| NPI: | 1235420258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNAPP | ||||||||
| FirstName: | TAMRA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 860 | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049030860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078739841 | ||||||||
| FaxNumber: | 2078739845 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 E CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043305717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076261078 | ||||||||
| FaxNumber: | 2076222398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2011 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | TD1075 | ME | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.