Provider Demographics
NPI:1528049707
Name:KNOWLDEN, SUSAN K (CNMW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:KNOWLDEN
Suffix:
Gender:F
Credentials:CNMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4668
Mailing Address - Country:US
Mailing Address - Phone:814-723-8101
Mailing Address - Fax:814-723-2024
Practice Address - Street 1:2265 MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-4668
Practice Address - Country:US
Practice Address - Phone:814-723-8101
Practice Address - Fax:814-723-2024
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008605L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00025508901OtherUNIVERA HEALTHCARE
PA0018330460005Medicaid
PA219412OtherUPMC
PA624178OtherBLUE SHIELD
PA117964OtherUNISON/MEDPLUS
PA00025508901OtherUNIVERA HEALTHCARE
PA219412OtherUPMC