Provider Demographics
NPI:1750303137
Name:KNUTSON, ALICE B (NP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:B
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HARDING AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4861
Mailing Address - Country:US
Mailing Address - Phone:715-832-2200
Mailing Address - Fax:
Practice Address - Street 1:1720 HARDING AVE STE 1
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4861
Practice Address - Country:US
Practice Address - Phone:715-832-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2375363L00000X
WI139656163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41197100Medicaid
WIP00440992OtherRR MEDICARE
WI41197100Medicaid
WI034220270Medicare PIN