Provider Demographics
NPI:1831858604
Name:KNUTSON, SHARLYNN D (RN)
Entity type:Individual
Prefix:MRS
First Name:SHARLYNN
Middle Name:D
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHARLYNN
Other - Middle Name:D
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1710 67TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7863
Mailing Address - Country:US
Mailing Address - Phone:701-261-8541
Mailing Address - Fax:
Practice Address - Street 1:3523 45TH ST S STE 100
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8962
Practice Address - Country:US
Practice Address - Phone:701-203-5247
Practice Address - Fax:701-203-2903
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL13677164W00000X
ND201737163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No164W00000XNursing Service ProvidersLicensed Practical Nurse