Provider Demographics
NPI:1700817970
Name:MCDOWELL, GINA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:L
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:L
Other - Last Name:WILQUET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C CDE
Mailing Address - Street 1:515 S 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4074
Mailing Address - Country:US
Mailing Address - Phone:715-842-2834
Mailing Address - Fax:715-842-2834
Practice Address - Street 1:515 S 32ND AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4074
Practice Address - Country:US
Practice Address - Phone:715-842-2834
Practice Address - Fax:715-842-2834
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000191363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001174343Medicaid
DEP31682Medicare UPIN
DE008242D05Medicare ID - Type Unspecified