Provider Demographics
NPI:1063897163
Name:WETHAL, KARLA K (PA)
Entity type:Individual
Prefix:MS
First Name:KARLA
Middle Name:K
Last Name:WETHAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:L
Other - Last Name:KLITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2880 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3644
Practice Address - Country:US
Practice Address - Phone:608-263-7171
Practice Address - Fax:608-265-8060
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3539-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400232358Medicare PIN