Provider Demographics
NPI:1669472312
Name:HARALDSSON, CATHERINE ALEXANDRA (PA-C)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ALEXANDRA
Last Name:HARALDSSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:ALEXANDRA
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9500 BORMET DR STE 204
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8399
Mailing Address - Country:US
Mailing Address - Phone:708-346-4044
Mailing Address - Fax:708-346-3287
Practice Address - Street 1:27750 W HIGHWAY 22
Practice Address - Street 2:SUITE 100
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2379
Practice Address - Country:US
Practice Address - Phone:847-816-3000
Practice Address - Fax:877-676-1549
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000540A363AS0400X
WI2684-023363AS0400X
IL085001460363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1669472312Medicaid
WI1669472312Medicaid
ILP00352632Medicare PIN
IL970021993Medicare PIN
IN970024155Medicare PIN