Provider Demographics
NPI:1245846948
Name:KNOLL, MEGAN BLANCHE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BLANCHE
Last Name:KNOLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:BLANCHE
Other - Last Name:STULKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 S LOGAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:SD
Mailing Address - Zip Code:57533-1614
Mailing Address - Country:US
Mailing Address - Phone:605-835-9611
Mailing Address - Fax:
Practice Address - Street 1:110 S LOGAN AVE STE A
Practice Address - Street 2:
Practice Address - City:GREGORY
Practice Address - State:SD
Practice Address - Zip Code:57533-1614
Practice Address - Country:US
Practice Address - Phone:605-835-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
SD1396363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant