Provider Demographics
NPI:1093944308
Name:SCHENCK, KATHARINE W (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:W
Last Name:SCHENCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:W
Other - Last Name:HACKBARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:788 N. JEFFERSON STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3710
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-272-0859
Practice Address - Street 1:13133 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2419
Practice Address - Country:US
Practice Address - Phone:262-243-5044
Practice Address - Fax:262-243-2510
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2424363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1093944308Medicaid
WI736450065Medicare PIN
WI462100055Medicare PIN