Provider Demographics
NPI:1700870094
Name:KOTERBSKI, DAWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:KOTERBSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1345 RYAN PKWY
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102
Mailing Address - Country:US
Mailing Address - Phone:847-438-2144
Mailing Address - Fax:847-438-1597
Practice Address - Street 1:1345 RYAN PKWY
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102
Practice Address - Country:US
Practice Address - Phone:847-658-9555
Practice Address - Fax:847-658-2167
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001597363A00000X
IL085001597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204142OtherMEDICARE NUMBER