Provider Demographics
NPI:1730416066
Name:MADER, KATHERINE HELEN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:HELEN
Last Name:MADER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 PRINGLE AVE
Mailing Address - Street 2:STE 425
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-7385
Mailing Address - Country:US
Mailing Address - Phone:801-627-0515
Mailing Address - Fax:801-627-0517
Practice Address - Street 1:100 PRINGLE AVE STE 425
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-7385
Practice Address - Country:US
Practice Address - Phone:925-932-3800
Practice Address - Fax:925-933-3339
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58992363A00000X
UT7494142-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical