Provider Demographics
NPI:1811149156
Name:KNUDSON, RICHELLE MELANIE (MD)
Entity type:Individual
Prefix:MRS
First Name:RICHELLE
Middle Name:MELANIE
Last Name:KNUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RICHELLE
Other - Middle Name:MELANIE
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:
Practice Address - Street 1:2830 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1482
Practice Address - Country:US
Practice Address - Phone:701-323-6400
Practice Address - Fax:701-323-5677
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL10955390200000X
MN104460207N00000X
MN52270207N00000X
ND12939207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
ND18404Medicaid
MNP00839007OtherRAILROAD MEDICARE
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MNENROLLEDMedicaid