Provider Demographics
NPI:1093183071
Name:PIESCHEK, KATELYNN S (PA-C)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:S
Last Name:PIESCHEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATELYNN
Other - Middle Name:S
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:1630 COMMANCHE AVE STE 102
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5753
Practice Address - Country:US
Practice Address - Phone:920-433-6000
Practice Address - Fax:920-430-4719
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1129791OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS