MEDICARE: EMMA KATE DEWANE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	7214-23	WI

General Provider Information

NPI Number	:	1104537158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA KATE DEWANE PA

Provider Business Mailing Address
First Line	:	2403 FOLSOM ST
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-2435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 LAKELAND DR
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-1687
Country	:	US
Telephone Number	:	715-726-9248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	01/21/2026

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