Basic Information
Provider Information
NPI: 1952733909
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KNIGHT
FirstName: DENA
MiddleName: MICHELE
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 201 CEDAR ST SE
Address2: STE. 5640
City: ALBUQUERQUE
State: NM
PostalCode: 871064917
CountryCode: US
TelephoneNumber: 5058436168
FaxNumber: 5052479743
Practice Location
Address1: 201 CEDAR ST SE
Address2: STE. 5640
City: ALBUQUERQUE
State: NM
PostalCode: 871064917
CountryCode: US
TelephoneNumber: 5058436168
FaxNumber: 5052479743
Other Information
ProviderEnumerationDate: 08/01/2013
LastUpdateDate: 08/01/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X  Y Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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