Provider Demographics
NPI:1669670345
Name:HUNTER, CATHY ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:ANN
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 VILLAGE WALK LN STE F
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-9462
Mailing Address - Country:US
Mailing Address - Phone:920-542-3010
Mailing Address - Fax:920-699-9699
Practice Address - Street 1:480 VILLAGE WALK LN STE F
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038-9462
Practice Address - Country:US
Practice Address - Phone:920-542-3010
Practice Address - Fax:920-699-9699
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1669670345Medicaid
WI1669670345Medicaid