Provider Demographics
NPI:1770037715
Name:KNUTSON, JENNIFER R (NP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:R
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 1:530 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3723
Mailing Address - Country:US
Mailing Address - Phone:323-730-1663
Mailing Address - Fax:323-730-9961
Practice Address - Street 1:2409 S. VERMONT AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007
Practice Address - Country:US
Practice Address - Phone:323-730-1663
Practice Address - Fax:323-730-9961
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004553363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner