MEDICARE: LAUREEN S KNUTESON 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	1105-023	WI
2	363AM0700X	Medical Physician Assistant	1105-023	WI
3	363AS0400X	Surgical Physician Assistant	1105-023	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326096124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREEN S KNUTESON PA-C

Provider Business Mailing Address
First Line	:	707 W 2ND ST
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-2209
Country	:	US
Telephone Number	:	812-334-5081
Fax Number	:	812-334-5091

Provider Business Practice Location Address
First Line	:	707 W 2ND ST
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-2209
Country	:	US
Telephone Number	:	812-334-5081
Fax Number	:	812-334-5091

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/30/2019

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Directions to “ LAUREEN S KNUTESON PA-C” Practice Location

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