Healthcare Provider Details

I. General information

NPI: 1750083812
Provider Name (Legal Business Name): ALEXIS JOY KNUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W CHARLESTON BLVD STE 490
LAS VEGAS NV
89102-2309
US

IV. Provider business mailing address

1707 W CHARLESTON BLVD
LAS VEGAS NV
89102-2351
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2273
  • Fax:
Mailing address:
  • Phone: 507-227-6075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1750083812
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: