Healthcare Provider Details

I. General information

NPI: 1114834025
Provider Name (Legal Business Name): IRISH ELLEN KNUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BECKER DR
LAWRENCE KS
66047-1620
US

IV. Provider business mailing address

2111 NAISMITH DR
LAWRENCE KS
66046-2751
US

V. Phone/Fax

Practice location:
  • Phone: 712-339-0322
  • Fax:
Mailing address:
  • Phone: 712-339-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3-123567
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: