Provider Demographics
NPI:1801299169
Name:KNUDSEN, ALEXANDER SCOTT (CRNA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:SCOTT
Last Name:KNUDSEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7506 TALL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5362
Mailing Address - Country:US
Mailing Address - Phone:435-729-0202
Mailing Address - Fax:
Practice Address - Street 1:7506 TALL OAKS DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5362
Practice Address - Country:US
Practice Address - Phone:435-729-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172118367500000X
UT7437932-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered