Provider Demographics
NPI:1144707209
Name:RATHMAN, KATARZYNA MARTA (PA)
Entity type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:MARTA
Last Name:RATHMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATARZYNA
Other - Middle Name:
Other - Last Name:BANAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3340 E GOLDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-9342
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:1510 12TH AVE RD STE 200
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6008
Practice Address - Country:US
Practice Address - Phone:208-302-6800
Practice Address - Fax:208-302-6855
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-22
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IDPA-2231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty