Provider Demographics
NPI:1962044073
Name:KNUDSEN, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:KNUDSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8236 ELM DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9039
Mailing Address - Country:US
Mailing Address - Phone:231-883-5196
Mailing Address - Fax:
Practice Address - Street 1:3785 VETERANS DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4516
Practice Address - Country:US
Practice Address - Phone:231-946-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator