Provider Demographics
NPI:1437927241
Name:KNUTSON, CARLIE BETH (PA)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:BETH
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 220TH ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:IA
Mailing Address - Zip Code:50482-8905
Mailing Address - Country:US
Mailing Address - Phone:641-430-3677
Mailing Address - Fax:
Practice Address - Street 1:2000 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-5050
Practice Address - Country:US
Practice Address - Phone:563-589-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant