Healthcare Provider Details

I. General information

NPI: 1790483774
Provider Name (Legal Business Name): GABRIELLE RAE STEINER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13250 WASHINGTON AVE
MOUNT PLEASANT WI
53177-1516
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-799-8700
  • Fax:
Mailing address:
  • Phone: 414-219-6777
  • Fax: 414-219-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7524
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: