Provider Demographics
NPI:1134202559
Name:KNUDSVIG, CHRISTINE LORRAINE (ACNP-BC, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LORRAINE
Last Name:KNUDSVIG
Suffix:
Gender:F
Credentials:ACNP-BC, FNP-BC
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:LORRAINE
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC, FNP-BC
Mailing Address - Street 1:701 1ST STREET SW
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730
Mailing Address - Country:US
Mailing Address - Phone:701-965-6349
Mailing Address - Fax:
Practice Address - Street 1:701 1ST STREET SW
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730
Practice Address - Country:US
Practice Address - Phone:701-965-6349
Practice Address - Fax:701-965-6407
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28157510A163WE0003X
IN71002692A363LA2100X
NDR42647363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1466445Medicaid
IN165460E4Medicare PIN