Provider Demographics
NPI:1043326754
Name:LOEFFLER, KATHRYN M (PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:LOEFFLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86 SDS 12 2901
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-2901
Mailing Address - Country:US
Mailing Address - Phone:651-968-5050
Mailing Address - Fax:651-968-5900
Practice Address - Street 1:310 SMITH AVE N STE 370
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2383
Practice Address - Country:US
Practice Address - Phone:651-968-5250
Practice Address - Fax:651-968-5901
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN407898500Medicaid
S88272Medicare UPIN
MN407898500Medicaid