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Individual

JAMIE LYNN KNUTH PRATHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
ME116201
FL
2086S0127X
Trauma Surgery Physician
Primary
65623
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
015136800
FL
01
151KP
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/26/2008
Last updated
07/25/2016
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