Basic Information
| Provider Information | |||||||||
| NPI: | 1629232095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNUDTSON | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ENDRES | ||||||||
| OtherFirstName: | ERIN | ||||||||
| OtherMiddleName: | MARY | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3 CENTURY AVE SE | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553503108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205872020 | ||||||||
| FaxNumber: | 3204844686 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 CENTURY AVE SE | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553503108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205872020 | ||||||||
| FaxNumber: | 3204844686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2008 | ||||||||
| LastUpdateDate: | 06/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 51384 | MN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.