Provider Demographics
NPI:1619274503
Name:KNUTSON, HEIDI PATRICIA (RN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:PATRICIA
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 NW COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2309
Mailing Address - Country:US
Mailing Address - Phone:541-610-4237
Mailing Address - Fax:
Practice Address - Street 1:1325 NW COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2309
Practice Address - Country:US
Practice Address - Phone:541-610-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200743791RN163W00000X
CA789490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse