Provider Demographics
NPI:1104046606
Name:KNOOP, LAURA ROCHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ROCHELLE
Last Name:KNOOP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 READING RD STE N
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2654
Mailing Address - Country:US
Mailing Address - Phone:513-604-1004
Mailing Address - Fax:513-437-0571
Practice Address - Street 1:969 READING RD STE N
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-604-1004
Practice Address - Fax:513-437-0571
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.000837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080386Medicaid
OHH065600Medicare PIN