Individual
KEVIN MICHAEL KNOBLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114
(617) 726-2000
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2696
(617) 726-2000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2258603
MA
363L00000X
Nurse Practitioner
Primary
RN2258603
MA
363LA2200X
Adult Health Nurse Practitioner
RN2258603
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110090058A
—
MA
Enumeration date
04/25/2011
Last updated
07/25/2022
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