Provider Demographics
NPI:1316971328
Name:KNUTT, DANIELLE DENAE (RD LD)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:DENAE
Last Name:KNUTT
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:DENAE
Other - Last Name:DOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:411 BRENTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310
Mailing Address - Country:US
Mailing Address - Phone:505-437-3264
Mailing Address - Fax:
Practice Address - Street 1:1402 INDIAN WELLS ROAD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:505-434-9764
Practice Address - Fax:505-434-9768
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD0586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM05570280Medicaid