Provider Demographics
NPI:1679522650
Name:KNUDTSEN, JEANNE A (CNM)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:A
Last Name:KNUDTSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7997 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4226
Mailing Address - Country:US
Mailing Address - Phone:216-851-1880
Mailing Address - Fax:216-707-9370
Practice Address - Street 1:7997 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4226
Practice Address - Country:US
Practice Address - Phone:216-851-1880
Practice Address - Fax:216-707-9370
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01640NM176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0765971Medicaid
OHNM01837Medicare PIN
OHNM01835Medicare PIN
OHNM01836Medicare PIN