Provider Demographics
NPI:1013514017
Name:KNUTSON, NICHOLAS (MPH)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 W HOLLY BERRY WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-4087
Mailing Address - Country:US
Mailing Address - Phone:520-343-1238
Mailing Address - Fax:
Practice Address - Street 1:2030 E BROADWAY BLVD STE 113
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5908
Practice Address - Country:US
Practice Address - Phone:520-343-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth Educator