Provider Demographics
NPI:1871098111
Name:KNAPP, AUSTEN NICOLE (MD)
Entity type:Individual
Prefix:
First Name:AUSTEN
Middle Name:NICOLE
Last Name:KNAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3725
Mailing Address - Country:US
Mailing Address - Phone:616-954-2020
Mailing Address - Fax:616-949-0408
Practice Address - Street 1:5030 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3725
Practice Address - Country:US
Practice Address - Phone:616-954-2020
Practice Address - Fax:616-949-0408
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA177155207W00000X
MI4351028281207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology