MEDICARE: STEFFANY MARIE DI BIASE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	9064-033	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679032148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFFANY MARIE DI BIASE

Provider Business Mailing Address
First Line	:	3301 W FOREST HOME AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2843
Country	:	US
Telephone Number	:	414-389-2377
Fax Number	:

Provider Business Practice Location Address
First Line	:	3237 VOYAGER DR
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-8349
Country	:	US
Telephone Number	:	920-468-8288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	11/30/2021

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