Basic Information
| Provider Information | |||||||||
| NPI: | 1346402757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNIERIM | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 E GOLDSTONE WAY | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836421026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083023900 | ||||||||
| FaxNumber: | 2083023905 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 N CURTIS ROAD | ||||||||
| Address2: | STE 501 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083023900 | ||||||||
| FaxNumber: | 2083023905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207X00000X | M-13829 | ID | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 14737 | NV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 5867 | NE | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | 14737 | NV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207XX0801X | M-13829 | ID | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
ID Information
| ID | Type | State | Issuer | Description | 28061 | 01 | NE | NEBRASKA LICENSE | OTHER |