Provider Demographics
NPI:1811080104
Name:KNUTSON, GEORGEANNA DUL (CNP)
Entity type:Individual
Prefix:
First Name:GEORGEANNA
Middle Name:DUL
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-5099
Mailing Address - Fax:320-229-5171
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-5099
Practice Address - Fax:320-229-5171
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-115788-4363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500003601Medicare PIN