Provider Demographics
NPI:1871985333
Name:KNUDSEN, JON (NP)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:KNUDSEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E CALDWELL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7605
Mailing Address - Country:US
Mailing Address - Phone:559-622-9800
Mailing Address - Fax:559-622-9871
Practice Address - Street 1:215 E CALDWELL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-7605
Practice Address - Country:US
Practice Address - Phone:559-622-9800
Practice Address - Fax:559-622-9871
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily