Provider Demographics
NPI:1891762159
Name:WIRTZ, KATHRYN (PA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:WIRTZ
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3300 N 124TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3106
Mailing Address - Country:US
Mailing Address - Phone:414-778-6200
Mailing Address - Fax:414-778-6222
Practice Address - Street 1:W227N6103 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3969
Practice Address - Country:US
Practice Address - Phone:414-566-8100
Practice Address - Fax:414-566-8038
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2022-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI339-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant