Provider Demographics
NPI:1972754083
Name:KNUTSON, BRIAN L (PA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3919 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1349
Mailing Address - Country:US
Mailing Address - Phone:509-444-8888
Mailing Address - Fax:509-444-7806
Practice Address - Street 1:9227 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3768
Practice Address - Country:US
Practice Address - Phone:509-444-8888
Practice Address - Fax:509-444-7806
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60052149363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical