Provider Demographics
NPI:1811942089
Name:MAAS, KATHLEEN SUE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUE
Last Name:MAAS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:744 S WEBSTER AVE
Mailing Address - Street 2:P.O. BOX 23400
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-433-3500
Mailing Address - Fax:920-433-7971
Practice Address - Street 1:2318 LINEVILLE RD
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54313-8836
Practice Address - Country:US
Practice Address - Phone:920-433-3500
Practice Address - Fax:920-433-7971
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2102-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI078450063Medicare Oscar/Certification
WI075100130Medicare Oscar/Certification