Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 20368 | AZ |
Y | 207N00000X | Dermatologist | MD60661694 | WA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 20368 | AZ |
N | 207NS0135X | Procedural Dermatology | 20368 | AZ |
NPI | 1306863030 |
---|---|
Provider Name | Cynthia Ackerman Knutson |
First Address | Seattle, WA 98104-1306 |
Second Address | Seattle, WA 98104-1306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070010620 | RR MEDICARE (01) | AZ |
395021 | (05) | AZ |
F80107 | (02) |