Basic Information
| Provider Information | |||||||||
| NPI: | 1750583092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNOWLES | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2168 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897022168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754458790 | ||||||||
| FaxNumber: | 7754457611 | ||||||||
| Practice Location | |||||||||
| Address1: | 2874 N CARSON ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897060251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457170 | ||||||||
| FaxNumber: | 7758830959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 03/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 14138 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 1184601239 | 05 | NV | MEDICAID |