Individual
KATHRYN A MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9555 76TH ST # 1200, PLEASANT PRAIRIE, WI 53158-1984
(262) 671-7300
(262) 671-7315
Mailing address
111 E WISCONSIN AVE STE 2000, MILWAUKEE, WI 53202-4809
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085010142
IL
363A00000X
Physician Assistant
4512-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083195580
—
WI
01
—
4512-23
WI LICENSE
WI
Enumeration date
08/23/2018
Last updated
04/04/2024
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