Individual
KATHRYN JO MCNALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1937 WASHINGTON ST APT 24, DAVENPORT, IA 52804-2162
(815) 993-7072
Mailing address
5676 STATELINE RD, SOUTH BELOIT, IL 61080-9512
(815) 993-7072
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7799-23
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/05/2022
Last updated
05/29/2024
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