Provider Demographics
NPI:1245950807
Name:KNUTSON, BRAUN (CERTIFIED PEER SUPP)
Entity type:Individual
Prefix:
First Name:BRAUN
Middle Name:
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:CERTIFIED PEER SUPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EAST BROADWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-222-0386
Mailing Address - Fax:701-255-4891
Practice Address - Street 1:101 EAST BROADWAY AVENUE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-222-0386
Practice Address - Fax:701-255-4891
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND249175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist