Healthcare Provider Details

I. General information

NPI: 1518997162
Provider Name (Legal Business Name): KATHERINE E PARKINSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 TIMBERLANE RD
SPOONER WI
54801-9687
US

IV. Provider business mailing address

114 TIMBERLANE RD
SPOONER WI
54801-9687
US

V. Phone/Fax

Practice location:
  • Phone: 715-635-3766
  • Fax: 715-635-3711
Mailing address:
  • Phone: 715-635-3766
  • Fax: 715-635-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number36649020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: