Provider Demographics
NPI:1093876781
Name:KNUDSON, TERRI A
Entity Type:Individual
Prefix:MISS
First Name:TERRI
Middle Name:A
Last Name:KNUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 HEWITT AVENUE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3821
Mailing Address - Country:US
Mailing Address - Phone:425-259-0144
Mailing Address - Fax:425-339-6024
Practice Address - Street 1:2909 HEWITT AVENUE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3821
Practice Address - Country:US
Practice Address - Phone:425-259-0144
Practice Address - Fax:425-339-6024
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA08933OtherL&I
WA9186107Medicaid
WA9015413OtherMEDICAID
WA9186107Medicaid