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NPI Code Detail

MEDICARE: MR. PHILIP DOUGLAS KNESE CNP

MEDICARE: MR. PHILIP DOUGLAS KNESE CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner247144-30WI
2363LF0000XFamily Nurse Practitioner5765MN

General Provider Information

NPI Number : 1225534977
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHILIP DOUGLAS KNESE CNP
Provider Business Mailing Address
First Line : 4498 UGSTAD RD UNIT 217
Second Line :
City : HERMANTOWN
State : MN
Zip : 55811-6600
Country : US
Telephone Number : 218-491-0853
Fax Number :
Provider Business Practice Location Address
First Line : 2420 W DIVISION ST
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56301-3926
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2018
Last Update Date : 07/10/2025

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