Healthcare Provider Details

I. General information

NPI: 1598080145
Provider Name (Legal Business Name): KATHERINE ROSE MCKENNA HOPPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 8TH AVE SE
CEDAR RAPIDS IA
52401-2134
US

IV. Provider business mailing address

500 8TH AVE SE
CEDAR RAPIDS IA
52401-2134
US

V. Phone/Fax

Practice location:
  • Phone: 319-364-8704
  • Fax: 131-965-7747
Mailing address:
  • Phone: 319-364-8704
  • Fax: 131-965-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-44025
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56718-20
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: