Healthcare Provider Details

I. General information

NPI: 1669303483
Provider Name (Legal Business Name): JACOB CHRISTOPHER KNUDSVIG-PARTIDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 7TH ST
BISMARCK ND
58501-4439
US

IV. Provider business mailing address

1012 LAKE AVE
BISMARCK ND
58504-5244
US

V. Phone/Fax

Practice location:
  • Phone: 951-990-6980
  • Fax:
Mailing address:
  • Phone: 951-990-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number204974
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: