MEDICARE: MISS CARA DIANE KNUTSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	15645	MN

General Provider Information

NPI Number	:	1174303481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CARA DIANE KNUTSON PA-C

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	612-262-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	11850 BLACKFOOT ST NW STE 450
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-2773
Country	:	US
Telephone Number	:	763-236-0800
Fax Number	:	763-236-1312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	03/04/2026

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