Healthcare Provider Details

I. General information

NPI: 1154586717
Provider Name (Legal Business Name): KATHLEEN ANNE KNIPFER P.A. C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E COTTAGE GROVE RD
COTTAGE GROVE WI
53527-9619
US

IV. Provider business mailing address

251 E COTTAGE GROVE RD
COTTAGE GROVE WI
53527-9619
US

V. Phone/Fax

Practice location:
  • Phone: 608-839-3515
  • Fax: 608-839-3541
Mailing address:
  • Phone: 608-839-3515
  • Fax: 608-839-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2313-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: