Basic Information
| Provider Information | |||||||||
| NPI: | 1730436288 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNAEBLE | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4729 COUNTY ROAD 101 | ||||||||
| Address2: | |||||||||
| City: | MINNETONKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553452634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529743200 | ||||||||
| FaxNumber: | 9529743201 | ||||||||
| Practice Location | |||||||||
| Address1: | 4729 COUNTY ROAD 101 | ||||||||
| Address2: | |||||||||
| City: | MINNETONKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553452634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529743200 | ||||||||
| FaxNumber: | 9529743201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2012 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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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 | 363A00000X | 1748 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.