Provider Demographics
NPI:1225103617
Name:KNUTZEN, SUZANNE GAUDINEER (NP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:GAUDINEER
Last Name:KNUTZEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2989 STEEPLE CHASE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1450
Mailing Address - Country:US
Mailing Address - Phone:909-591-9988
Mailing Address - Fax:
Practice Address - Street 1:757 COLLEGE WAY
Practice Address - Street 2:STUDENT HEALTH SERVICES
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:909-607-8860
Practice Address - Fax:909-621-8472
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN334552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily