Healthcare Provider Details

I. General information

NPI: 1104440734
Provider Name (Legal Business Name): JENNA MARIE STEINGRABER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA MARIE MATTSON

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 HAZELWOOD ST STE 340
MAPLEWOOD MN
55109-1241
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W STE 110N
SAINT PAUL MN
55114-8693
US

V. Phone/Fax

Practice location:
  • Phone: 651-312-1620
  • Fax: 651-312-1570
Mailing address:
  • Phone: 651-602-5312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13754
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: