Provider Demographics
NPI:1396530697
Name:KNIGGE, MIRYAM ROSE (PA)
Entity type:Individual
Prefix:
First Name:MIRYAM
Middle Name:ROSE
Last Name:KNIGGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:743 MILLER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1813
Mailing Address - Country:US
Mailing Address - Phone:928-777-9600
Mailing Address - Fax:855-449-5560
Practice Address - Street 1:743 MILLER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1813
Practice Address - Country:US
Practice Address - Phone:928-777-9600
Practice Address - Fax:855-449-5560
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-05-20
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Provider Licenses
StateLicense IDTaxonomies
AZ11098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant