Provider Demographics
NPI:1538642855
Name:KNUDSON, DORENE JOYCE
Entity Type:Individual
Prefix:
First Name:DORENE
Middle Name:JOYCE
Last Name:KNUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 COMMONWEALTH ST UNIT N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1868
Mailing Address - Country:US
Mailing Address - Phone:713-630-0090
Mailing Address - Fax:
Practice Address - Street 1:2100 COMMONWEALTH ST UNIT N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-1868
Practice Address - Country:US
Practice Address - Phone:713-630-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX435886163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics