Provider Demographics
NPI:1093523466
Name:KNUTSON, KALE JO (WHNP)
Entity type:Individual
Prefix:
First Name:KALE
Middle Name:JO
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5995 LINCOLN DR APT 143
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-6105
Mailing Address - Country:US
Mailing Address - Phone:320-874-0665
Mailing Address - Fax:
Practice Address - Street 1:14001 RIDGEDALE DR STE 200
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1747
Practice Address - Country:US
Practice Address - Phone:952-249-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12400363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health