Provider Demographics
NPI:1144803057
Name:KNUDSVIG, CHRISTOPHER BARNETT
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BARNETT
Last Name:KNUDSVIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 EWING AVE S APT 137
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4227
Mailing Address - Country:US
Mailing Address - Phone:920-544-6686
Mailing Address - Fax:
Practice Address - Street 1:16180 HASTINGS AVE SE STE 205
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-9228
Practice Address - Country:US
Practice Address - Phone:952-443-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program