Provider Demographics
NPI:1598231623
Name:MONDADA, KATHERINE LINDSAY (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LINDSAY
Last Name:MONDADA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LINDSAY
Other - Last Name:MONDADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-8752
Mailing Address - Fax:
Practice Address - Street 1:9951 W ST LUKES DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7914
Practice Address - Country:US
Practice Address - Phone:208-467-6700
Practice Address - Fax:208-463-6044
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61091674363A00000X
IDPA-1658363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant