Basic Information
| Provider Information | |||||||||
| NPI: | 1962854935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNUTSON | ||||||||
| FirstName: | JANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 S MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | RUGBY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583682118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017765235 | ||||||||
| FaxNumber: | 7017765297 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 MAIN ST SE | ||||||||
| Address2: | |||||||||
| City: | DUNSEITH | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583290088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012445694 | ||||||||
| FaxNumber: | 7012445329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2016 | ||||||||
| LastUpdateDate: | 02/28/2017 | ||||||||
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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 | 363LF0000X | R40025 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1468190 | 05 | ND | MEDICAID |