Provider Demographics
NPI:1477191724
Name:METZGER, KATHRYN OLIVIA (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:OLIVIA
Last Name:METZGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 CHICAGO AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1353
Mailing Address - Country:US
Mailing Address - Phone:651-225-7800
Mailing Address - Fax:
Practice Address - Street 1:2800 CHICAGO AVE STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1353
Practice Address - Country:US
Practice Address - Phone:651-225-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MN13481363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant