Healthcare Provider Details

I. General information

NPI: 1699460717
Provider Name (Legal Business Name): KATHERINE RACHEL VAN ES KOMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE VAN ES

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S MAIN ST
VIROQUA WI
54665-2059
US

IV. Provider business mailing address

507 S MAIN ST
VIROQUA WI
54665-2059
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-2101
  • Fax:
Mailing address:
  • Phone: 608-637-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86031-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: