1598867442 NPI number — MARCIA M KNUTSON ARNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598867442 NPI number — MARCIA M KNUTSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNUTSON
Provider First Name:
MARCIA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598867442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
621 S ILLINOIS AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MASON CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50401-5489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-494-3041
Provider Business Mailing Address Fax Number:
641-494-3059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 4TH ST SW
Provider Second Line Business Practice Location Address:
SUITE WC
Provider Business Practice Location Address City Name:
MASON CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50401-2737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-422-7498
Provider Business Practice Location Address Fax Number:
641-422-6484
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  060656 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36500 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0443150 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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