Provider Demographics
NPI:1487663316
Name:KNUTSON, MARY (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:ZALAZNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:66447 BOLTON RD
Mailing Address - Street 2:
Mailing Address - City:DUFUR
Mailing Address - State:OR
Mailing Address - Zip Code:97021-3019
Mailing Address - Country:US
Mailing Address - Phone:541-993-1744
Mailing Address - Fax:
Practice Address - Street 1:3641 KLINDT DR
Practice Address - Street 2:DEPARTMENT OF HUMAN SERVICES
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3565
Practice Address - Country:US
Practice Address - Phone:541-298-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200440802RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR098372Medicaid