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General NPI Number Information
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NPI Number | 1700452117
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Entity Type | Individual
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Provider Name | KATELYNN KNIPPER PAC
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Gender | Female
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 535 CEDAR CROSS RD
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City | DUBUQUE
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State | IA
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Zip | 52003-7704
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Country | US
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Telephone | 563-588-0506
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Fax |
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Provider Business Mailing Address
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Address Line | 535 CEDAR CROSS RD
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City | DUBUQUE
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State | IA
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Zip | 52003-7704
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Country | US
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Telephone | 563-588-0506
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5437-23
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 107503
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License Number State | IA
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