Provider Demographics
NPI:1477676229
Name:KNUTE NELSON
Entity Type:Organization
Organization Name:KNUTE NELSON
Other - Org Name:KNUTE NELSON HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUGISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-763-1164
Mailing Address - Street 1:2209 JEFFERSON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2848
Mailing Address - Country:US
Mailing Address - Phone:320-763-1164
Mailing Address - Fax:320-759-4913
Practice Address - Street 1:2715 HIGHWAY 29 S
Practice Address - Street 2:SUITE 103
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4548
Practice Address - Country:US
Practice Address - Phone:320-759-1273
Practice Address - Fax:320-759-1275
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KNUTE NELSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN370399251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN675492900Medicaid
248096Medicare Oscar/Certification