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Individual
MARY JANE KNIGHT
Active
Individual
MARY JANE KNIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
006582267
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2161636
MEDICAID PROVIDER #
LA
Enumeration date
10/17/2011
Last updated
10/17/2011
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