Healthcare Provider Details

I. General information

NPI: 1245025527
Provider Name (Legal Business Name): SKYLAR MAE STELTER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 E CENTENNIAL DR
OAK CREEK WI
53154-8618
US

IV. Provider business mailing address

1025 E STONEGATE DR
OAK CREEK WI
53154-3924
US

V. Phone/Fax

Practice location:
  • Phone: 414-483-1820
  • Fax:
Mailing address:
  • Phone: 414-736-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001788-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: