Provider Demographics
NPI:1194704437
Name:KNUDSEN, VALERIE A (MD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:A
Last Name:KNUDSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-1130
Mailing Address - Country:US
Mailing Address - Phone:406-443-3076
Mailing Address - Fax:406-449-6531
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:SUITE 306
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7419
Practice Address - Country:US
Practice Address - Phone:406-327-4395
Practice Address - Fax:406-327-4394
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5310207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0021863Medicaid
81054459959804A001OtherWPS TRICARE
MT0042245Medicaid
ID0021863Medicaid