| Doctor Name: | SHIRLEY KNACKSTEDT |
| NPI Number: | 1114908761 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CFNP |
| License Number: | R39671/CNP00873 |
| Business Practice Address: | 7218 4th St Nw Los Ranchos, NM - 871076624 |
| Business Phone Number: | 5057305603 |
| Business Fax Number: | 5055542313 |
| Mailing Address: | 7218 4th St Nw, LOS RANCHOS |
| State: | NM |
| Postal Code: | 871076624 |
| Phone Number: | 5057305603 |
| Fax Number: | 5055542313 |
| NPI Enumeration Date: | 11/10/2005 |
| NPI Last Update Date: | 04/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R39671/CNP00873 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |