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NPI Code Detail

MEDICARE: KATHERINE E. GUNDERSON PA-C

MEDICARE: KATHERINE E. GUNDERSON PA-C
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
1363A00000XPhysician Assistant3892-23WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396293890
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE E. GUNDERSON PA-C
Provider Business Mailing Address
First Line : 700 S PARK ST
Second Line :
City : MADISON
State : WI
Zip : 53715-1830
Country : US
Telephone Number : 608-251-6100
Fax Number : 608-260-2976
Provider Business Practice Location Address
First Line : 3400 DEERFIELD DR
Second Line :
City : JANESVILLE
State : WI
Zip : 53546-3557
Country : US
Telephone Number : 608-314-3600
Fax Number : 608-314-3601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2016
Last Update Date : 07/13/2021

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