Provider Demographics
NPI:1487812079
Name:KNAUS, MADONNA MARY (RN)
Entity type:Individual
Prefix:MS
First Name:MADONNA
Middle Name:MARY
Last Name:KNAUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 STERLING ROAD
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2162
Mailing Address - Country:US
Mailing Address - Phone:440-943-4630
Mailing Address - Fax:
Practice Address - Street 1:690 STERLING ROAD
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2162
Practice Address - Country:US
Practice Address - Phone:440-943-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21110242163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2687598Medicare UPIN