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General NPI Number Information
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NPI Number | 1396293890
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Entity Type | Individual
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Provider Name | KATHERINE E. GUNDERSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 3400 DEERFIELD DR
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City | JANESVILLE
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State | WI
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Zip | 53546-3557
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Country | US
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Telephone | 608-314-3600
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Fax | 608-314-3601
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Provider Business Mailing Address
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Address Line | 700 S PARK ST
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City | MADISON
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State | WI
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Zip | 53715-1830
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Country | US
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Telephone | 608-251-6100
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Fax | 608-260-2976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3892-23
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License Number State | WI
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