Basic Information
| Provider Information | |||||||||
| NPI: | 1023103348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNOWLTON | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 254 | ||||||||
| Address2: | |||||||||
| City: | YELM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538475650 | ||||||||
| FaxNumber: | 2538475653 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 LIMITED LANE NW | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603579392 | ||||||||
| FaxNumber: | 3603579392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00024444 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0156219 | 01 | WA | LABOR & INDUSTRY | OTHER | 128044 | 01 | WA | LABOR & INDUSTRY | OTHER | 1108588 | 05 | WA | MEDICAID | 8240541 | 05 | WA | MEDICAID |