Provider Demographics
NPI:1952866725
Name:SUDA, KATE MEREDITH WHELAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:MEREDITH WHELAN
Last Name:SUDA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1113 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2139
Mailing Address - Country:US
Mailing Address - Phone:701-352-4048
Mailing Address - Fax:
Practice Address - Street 1:1113 W 11TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2139
Practice Address - Country:US
Practice Address - Phone:701-352-4048
Practice Address - Fax:701-922-1308
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDPAC0764363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant