Healthcare Provider Details

I. General information

NPI: 1497744387
Provider Name (Legal Business Name): CAMPBELL KNUTSON BRASINGTON M.S., C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY CAMPBELL KNUTSON M.S., C.G.C.

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD CAROLINAS MEDICAL CENTER, CLINICAL GENETICS
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

1000 BLYTHE BLVD CAROLINAS MEDICAL CENTER, CLINICAL GENETICS
CHARLOTTE NC
28203-5812
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-6810
  • Fax: 704-381-6811
Mailing address:
  • Phone: 704-381-6810
  • Fax: 704-381-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: