Provider Demographics
NPI:1972720134
Name:KOPISCHKE, CATHERINE ANNE (MS, PA-C)
Entity Type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:ANNE
Last Name:KOPISCHKE
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
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Mailing Address - Street 1:4240 PARK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5427
Mailing Address - Country:US
Mailing Address - Phone:612-925-6033
Mailing Address - Fax:612-925-8496
Practice Address - Street 1:6950 146TH ST W STE 100
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6544
Practice Address - Country:US
Practice Address - Phone:952-432-1484
Practice Address - Fax:952-432-2328
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN11956363A00000X
WI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA003022201Medicare PIN