Individual
HEATHER MARIE KNUDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1160 LIBERTY ST SE, SALEM, OR 97302-4143
(503) 391-9762
Mailing address
1160 LIBERTY ST SE, SALEM, OR 97302-4143
(503) 391-9762
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
202202735LPN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202202735LPN
—
OR
Enumeration date
04/06/2022
Last updated
04/06/2022
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