Provider Demographics
NPI:1225674971
Name:TOMSCHA, KATHERINE ELLEN TILTON (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELLEN TILTON
Last Name:TOMSCHA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ELLEN WILSON
Other - Last Name:TILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9855 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4648
Mailing Address - Country:US
Mailing Address - Phone:763-581-5900
Mailing Address - Fax:763-581-5901
Practice Address - Street 1:9855 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4648
Practice Address - Country:US
Practice Address - Phone:763-581-5900
Practice Address - Fax:763-581-5901
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant