Provider Demographics
NPI:1538472352
Name:KNUTSON, SUSAN (RN, BSN, MA-HSM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:RN, BSN, MA-HSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 3RD AVE SE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4619
Mailing Address - Country:US
Mailing Address - Phone:507-288-8544
Mailing Address - Fax:507-288-8545
Practice Address - Street 1:300 3RD AVE SE
Practice Address - Street 2:SUITE 405
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4619
Practice Address - Country:US
Practice Address - Phone:507-288-8544
Practice Address - Fax:507-288-8545
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR77566-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR77566-5OtherREGISTERED NURSE LICENSE