Provider Demographics
NPI:1275027112
Name:VANKOUWENBERG, KATRINA MICHELLE (PA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MICHELLE
Last Name:VANKOUWENBERG
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3085 HARLEM RD STE 350
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2591
Mailing Address - Country:US
Mailing Address - Phone:716-844-5600
Mailing Address - Fax:716-844-5750
Practice Address - Street 1:3085 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2591
Practice Address - Country:US
Practice Address - Phone:716-844-5000
Practice Address - Fax:716-844-5750
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2019-06-06
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant