MEDICARE: MRS. DANA MICHELLE KNUTZEN M.S.

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
1	170300000X	Genetic Counselor (M.S.)	GT60205856	WA

General Provider Information

NPI Number	:	1609865831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA MICHELLE KNUTZEN M.S.

Provider Business Mailing Address
First Line	:	11511 CANTERWOOD BLVD NW
Second Line	:	STE 45
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-5813
Country	:	US
Telephone Number	:	253-426-4772
Fax Number	:	253-426-6449

Provider Business Practice Location Address
First Line	:	11511 CANTERWOOD BLVD NW
Second Line	:	STE 45
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-5813
Country	:	US
Telephone Number	:	253-426-4772
Fax Number	:	253-426-6449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	05/04/2015

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