Provider Demographics
NPI:1346757523
Name:SCHWAKE, KATHRYN ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:SCHWAKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W 42ND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1766
Mailing Address - Country:US
Mailing Address - Phone:612-432-5103
Mailing Address - Fax:
Practice Address - Street 1:2401 W 42ND ST APT 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1766
Practice Address - Country:US
Practice Address - Phone:612-432-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12606363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant