Provider Demographics
NPI:1306071410
Name:MCKNIGHT, DEBRA LEANOR
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEANOR
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-1655
Mailing Address - Country:US
Mailing Address - Phone:208-878-2321
Mailing Address - Fax:208-878-9960
Practice Address - Street 1:239 W 13TH ST
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1655
Practice Address - Country:US
Practice Address - Phone:208-878-2321
Practice Address - Fax:208-878-9960
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory