Provider Demographics
NPI:1518692391
Name:KLOPFER, BRIANNA LAURA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LAURA
Last Name:KLOPFER
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 1:919 N HARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1450
Mailing Address - Country:US
Mailing Address - Phone:262-844-7978
Mailing Address - Fax:
Practice Address - Street 1:1401 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1259
Practice Address - Country:US
Practice Address - Phone:773-229-1414
Practice Address - Fax:773-229-1414
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085009728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant