Provider Demographics
NPI:1528289394
Name:KNUDTSON, LILIA VASHTI (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:LILIA
Middle Name:VASHTI
Last Name:KNUDTSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:LILIA
Other - Middle Name:VASHTI
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:3329-A EAST LOCHLEVEN LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869
Mailing Address - Country:US
Mailing Address - Phone:714-639-4101
Mailing Address - Fax:714-744-8630
Practice Address - Street 1:353 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-771-8000
Practice Address - Fax:714-744-8630
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN217087163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice