Healthcare Provider Details

I. General information

NPI: 1164976049
Provider Name (Legal Business Name): KRISTINA M KNUTSON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA MARIE DESOTELL R.N.

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 W OAKEY BLVD SUITE 4C
LAS VEGAS NV
89102-1535
US

IV. Provider business mailing address

PO BOX 15645
LAS VEGAS NV
89114-5645
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-5306
  • Fax:
Mailing address:
  • Phone: 702-579-3272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN18470
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: