Healthcare Provider Details

I. General information

NPI: 1720186729
Provider Name (Legal Business Name): PAULETTE FAY KNUTSON R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N DEPT OF VETERANS AFFAIRS 11C-B
FARGO ND
58102-2417
US

IV. Provider business mailing address

1209 48TH AVE S
FARGO ND
58104-6438
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3700
  • Fax: 701-237-2625
Mailing address:
  • Phone: 701-241-9721
  • Fax: 701-298-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number113132-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: