Healthcare Provider Details

I. General information

NPI: 1316853773
Provider Name (Legal Business Name): ALEXIS STEINSULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 1/2 N 1ST ST
VIENNA IL
62995-1849
US

IV. Provider business mailing address

10895 STATE ROUTE 37 N
GOREVILLE IL
62939-3040
US

V. Phone/Fax

Practice location:
  • Phone: 618-658-3784
  • Fax:
Mailing address:
  • Phone: 618-579-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number049.315339
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: