MEDICARE: HEIDI PATRICIA KNUTSON RN

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	163W00000X	Registered Nurse	200743791RN	OR
2	163W00000X	Registered Nurse	789490	CA

General Provider Information

NPI Number	:	1619274503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI PATRICIA KNUTSON RN

Provider Business Mailing Address
First Line	:	1325 NW COLUMBIA ST
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-2309
Country	:	US
Telephone Number	:	541-610-4237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 NW COLUMBIA ST
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-2309
Country	:	US
Telephone Number	:	541-610-4237
Fax Number	:

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

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	02/11/2011

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