Healthcare Provider Details

I. General information

NPI: 1902134224
Provider Name (Legal Business Name): KNUTSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N5272 HIGHWAY I
SAUKVILLE WI
53080-1040
US

IV. Provider business mailing address

N5272 HIGHWAY I
SAUKVILLE WI
53080-1040
US

V. Phone/Fax

Practice location:
  • Phone: 262-692-2474
  • Fax:
Mailing address:
  • Phone: 262-692-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number303726-031
License Number StateWI

VIII. Authorized Official

Name: MRS. NANCY E KNUTSON
Title or Position: LPN
Credential:
Phone: 262-692-2474