Healthcare Provider Details

I. General information

NPI: 1275446288
Provider Name (Legal Business Name): TANIA KNUTSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E MAIN ST
CROSBY MN
56441-1645
US

IV. Provider business mailing address

320 E MAIN ST
CROSBY MN
56441-1645
US

V. Phone/Fax

Practice location:
  • Phone: 218-545-1044
  • Fax:
Mailing address:
  • Phone: 218-545-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14815
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: