Provider Demographics
NPI:1245612548
Name:NIEKAMP, KATHERINE ANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANNE
Last Name:NIEKAMP
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:WALGREEN 2507
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1271
Mailing Address - Fax:847-570-2930
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:WALGREEN 2507
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-1271
Practice Address - Fax:847-570-2930
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2024-03-07
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Provider Licenses
StateLicense IDTaxonomies
IL085.005477363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical