Provider Demographics
NPI:1295286425
Name:SCHMITZ, KATLYN (PA-C)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:
Other - Last Name:SPADINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3433 BROADWAY ST NE STE 115
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1759
Mailing Address - Country:US
Mailing Address - Phone:651-312-1505
Mailing Address - Fax:651-312-1570
Practice Address - Street 1:1983 SLOAN PL
Practice Address - Street 2:SUITE 11
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2087
Practice Address - Country:US
Practice Address - Phone:651-312-1620
Practice Address - Fax:651-312-1570
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2613363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical