Provider Demographics
NPI:1316304777
Name:KNOOP, WHITNEY MARYRUTH (FNP)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:MARYRUTH
Last Name:KNOOP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:MARYRUTH
Other - Last Name:DUNCANSON-PEDEVILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1540 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2451
Mailing Address - Country:US
Mailing Address - Phone:937-492-1962
Mailing Address - Fax:
Practice Address - Street 1:1540 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2451
Practice Address - Country:US
Practice Address - Phone:937-492-1961
Practice Address - Fax:937-492-1962
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHAPRN.CNP.18684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program