Provider Demographics
NPI:1114917671
Name:KNUDSON, SANDRA DIXON (RNNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DIXON
Last Name:KNUDSON
Suffix:
Gender:F
Credentials:RNNP
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5635 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6331
Mailing Address - Country:US
Mailing Address - Phone:559-285-7188
Mailing Address - Fax:559-353-7463
Practice Address - Street 1:7555 N DEL MAR AVE
Practice Address - Street 2:#101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6860
Practice Address - Country:US
Practice Address - Phone:559-353-7125
Practice Address - Fax:559-353-7463
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235654163WH0200X, 163WP0200X
CA3089363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics