MEDICARE: MRS. HOLLY BRI KNUDSON FDN, CMTA, HHC

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	174H00000X	Health Educator	174H00000X	UT

General Provider Information

NPI Number	:	1558740522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY BRI KNUDSON FDN, CMTA, HHC

Provider Business Mailing Address
First Line	:	11433 S HIGH MOUNTAIN CIR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-5510
Country	:	US
Telephone Number	:	801-651-7579
Fax Number	:

Provider Business Practice Location Address
First Line	:	11433 S HIGH MOUNTAIN CIR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-5510
Country	:	US
Telephone Number	:	801-651-7579
Fax Number	:

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

Provider Enumeration Date	:	05/23/2015
Last Update Date	:	05/23/2015

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