Provider Demographics
NPI:1518192376
Name:LOTHE, KATHERINE A (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:LOTHE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1304
Mailing Address - Country:US
Mailing Address - Phone:920-648-4518
Mailing Address - Fax:920-648-1623
Practice Address - Street 1:1025 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1304
Practice Address - Country:US
Practice Address - Phone:920-648-4518
Practice Address - Fax:920-648-1623
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3931-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61112OtherDEAN HEALTH INSURANCE
WI741501796Medicare PIN
WIK400127392Medicare PIN