Provider Demographics
NPI:1902113475
Name:KNOKE, ANDREA L (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:KNOKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:PASKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:650 S WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9587
Mailing Address - Country:US
Mailing Address - Phone:231-271-6511
Mailing Address - Fax:231-271-6519
Practice Address - Street 1:650 S WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-9587
Practice Address - Country:US
Practice Address - Phone:231-271-6511
Practice Address - Fax:231-271-6519
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005837363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical