Provider Demographics
NPI:1144750829
Name:KNUTSON, MARY S (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:S
Other - Last Name:SCHOER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:IA
Mailing Address - Zip Code:50622-0390
Mailing Address - Country:US
Mailing Address - Phone:319-984-5645
Mailing Address - Fax:319-984-5364
Practice Address - Street 1:111 TOWER ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:IA
Practice Address - Zip Code:50622-2201
Practice Address - Country:US
Practice Address - Phone:319-984-5645
Practice Address - Fax:319-984-5364
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA109101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner