Individual
LAURA BRYCE KNUDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 N EAGLESON AVE, BLOOMINGTON, IN 47405-3190
(812) 855-6511
(128) 855-8722
Mailing address
600 N EAGLESON AVE, BLOOMINGTON, IN 47405-3190
(812) 855-6511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01073231A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000851661
ANTHEM PTAN
IN
01
—
090540053
MEDICARE PTAN
IN
05
—
201203450
—
IN
Enumeration date
11/01/2008
Last updated
06/20/2024
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