Provider Demographics
NPI:1386098572
Name:KNUCKLES, BRANDY D (CMA)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:D
Last Name:KNUCKLES
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-2320
Mailing Address - Country:US
Mailing Address - Phone:234-312-8692
Mailing Address - Fax:
Practice Address - Street 1:1442 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-2320
Practice Address - Country:US
Practice Address - Phone:234-312-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide