Provider Demographics
NPI:1124816749
Name:KNUTH, MICHELE LYNN (NP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:KNUTH
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E NAVARRE ST
Mailing Address - Street 2:SUITE 5500
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601
Mailing Address - Country:US
Mailing Address - Phone:574-647-5200
Mailing Address - Fax:
Practice Address - Street 1:100 E NAVARRE ST
Practice Address - Street 2:SUITE 5500
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-647-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016513A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily