Provider Demographics
NPI:1386386522
Name:KNISKERN, MEGAN A (MS, RD, LD/N, CEDS-S)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:KNISKERN
Suffix:
Gender:F
Credentials:MS, RD, LD/N, CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4354 E PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1128
Mailing Address - Country:US
Mailing Address - Phone:480-316-3081
Mailing Address - Fax:
Practice Address - Street 1:4354 E PALO VERDE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-1128
Practice Address - Country:US
Practice Address - Phone:480-316-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1016383133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1016383OtherRDN NUMBER