Provider Demographics
NPI:1447744388
Name:MCBRIDE, KARLEEN F (PA)
Entity Type:Individual
Prefix:
First Name:KARLEEN
Middle Name:F
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KARLEEN
Other - Middle Name:F
Other - Last Name:WOJCZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6871
Mailing Address - Fax:608-756-6836
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2940
Practice Address - Country:US
Practice Address - Phone:608-756-6871
Practice Address - Fax:608-756-6836
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4385-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI705853OtherMERCYCARE INSURANCE
WI1447744388Medicaid
WIK400489642OtherWI MEDICARE
WI1447744388OtherBCBSWI
WI1447744388Medicaid