Provider Demographics
NPI:1558740522
Name:KNUDSON, HOLLY BRI (FDN, CMTA, HHC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:BRI
Last Name:KNUDSON
Suffix:
Gender:F
Credentials:FDN, CMTA, HHC
Other - Prefix:MRS
Other - First Name:HOLLY
Other - Middle Name:BRI
Other - Last Name:ROYLANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11433 S HIGH MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5510
Mailing Address - Country:US
Mailing Address - Phone:801-651-7579
Mailing Address - Fax:
Practice Address - Street 1:11433 S HIGH MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-5510
Practice Address - Country:US
Practice Address - Phone:801-651-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-23
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174H00000X174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator