Provider Demographics
NPI:1871730499
Name:KNEBEL, JANET R (RN)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:R
Last Name:KNEBEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:R
Other - Last Name:BURD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12266 DEPAUL DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2514
Mailing Address - Country:US
Mailing Address - Phone:314-770-0991
Mailing Address - Fax:314-770-0692
Practice Address - Street 1:12266 DEPAUL DR
Practice Address - Street 2:SUITE 305
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2514
Practice Address - Country:US
Practice Address - Phone:314-770-0991
Practice Address - Fax:314-770-0692
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN082635163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy