Provider Demographics
NPI:1932503786
Name:POWERS, KATHERINE V (PA-C)
Entity Type:Individual
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First Name:KATHERINE
Middle Name:V
Last Name:POWERS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9524
Mailing Address - Country:US
Mailing Address - Phone:815-717-8730
Mailing Address - Fax:815-717-8729
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9524
Practice Address - Country:US
Practice Address - Phone:815-717-8730
Practice Address - Fax:815-717-8729
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
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Provider Licenses
StateLicense IDTaxonomies
IL085005330363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical