Basic Information
| Provider Information | |||||||||
| NPI: | 1790002012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNEBEL | ||||||||
| FirstName: | CORRIN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 E TOWN ST | ||||||||
| Address2: | SUITE 8-550 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145668883 | ||||||||
| FaxNumber: | 6145668149 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 E TOWN ST | ||||||||
| Address2: | SUITE 8-550 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145668883 | ||||||||
| FaxNumber: | 6145668149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2010 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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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 | 363LA2200X | 2008006137 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.