Healthcare Provider Details

I. General information

NPI: 1942745013
Provider Name (Legal Business Name): MEGAN KNUTSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY N
FARGO ND
58102-3641
US

IV. Provider business mailing address

2619 6TH ST W
WEST FARGO ND
58078-3061
US

V. Phone/Fax

Practice location:
  • Phone: 180-043-7122
  • Fax:
Mailing address:
  • Phone: 701-206-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR37209
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: