Provider Demographics
NPI:1265563803
Name:KNUDSEN, IRINA M (NP)
Entity type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:M
Last Name:KNUDSEN
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 1:2384 WATERFORD CV
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1332
Mailing Address - Country:US
Mailing Address - Phone:404-353-0869
Mailing Address - Fax:
Practice Address - Street 1:975 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 460
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1619
Practice Address - Country:US
Practice Address - Phone:404-832-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139660363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health