Provider Demographics
NPI:1316517022
Name:KNIEP-DIMMER, MANUELA
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:KNIEP-DIMMER
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 1:47624 HENNINGS ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4924
Mailing Address - Country:US
Mailing Address - Phone:586-321-9652
Mailing Address - Fax:
Practice Address - Street 1:11585 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2645
Practice Address - Country:US
Practice Address - Phone:586-751-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303035150183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician