Healthcare Provider Details

I. General information

NPI: 1184651184
Provider Name (Legal Business Name): PATRICIA G KNUTSEN AHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL STE 13B STE 13B
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8127
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-7300
  • Fax: 314-747-7065
Mailing address:
  • Phone: 314-747-7300
  • Fax: 314-747-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number056630
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number056630
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: