Healthcare Provider Details

I. General information

NPI: 1548946866
Provider Name (Legal Business Name): GABRIELLA JAMES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AIRPORT DR
ONEIDA WI
54155-9035
US

IV. Provider business mailing address

PO BOX 365
ONEIDA WI
54155-0365
US

V. Phone/Fax

Practice location:
  • Phone: 920-869-2711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number839623
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: