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Individual

LAUREEN S KNUTESON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
707 W 2ND ST, BLOOMINGTON, IN 47403-2209
(812) 334-5081
(812) 334-5091
Mailing address
707 W 2ND ST, BLOOMINGTON, IN 47403-2209
(812) 334-5081
(812) 334-5091

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1105-023
WI
363AM0700X
Medical Physician Assistant
1105-023
WI
363AS0400X
Surgical Physician Assistant
Primary
1105-023
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
42980300
WI
Enumeration date
05/04/2006
Last updated
07/30/2019
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