Provider Demographics
NPI:1215493903
Name:BIANCHI KNOD, ELIZABETH (CPO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BIANCHI KNOD
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5027 GREEN BAY RD STE 124
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1771
Mailing Address - Country:US
Mailing Address - Phone:262-654-4300
Mailing Address - Fax:262-654-4305
Practice Address - Street 1:5027 GREEN BAY RD STE 124
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1771
Practice Address - Country:US
Practice Address - Phone:262-654-4300
Practice Address - Fax:262-654-4305
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPO04219222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist