Provider Demographics
NPI:1720186729
Name:KNUTSON, PAULETTE FAY (RPH)
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:FAY
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 48TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6438
Mailing Address - Country:US
Mailing Address - Phone:701-241-9721
Mailing Address - Fax:701-298-6120
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:DEPT OF VETERANS AFFAIRS 11C-B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-239-3700
Practice Address - Fax:701-237-2625
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113132-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist