Healthcare Provider Details

I. General information

NPI: 1275482135
Provider Name (Legal Business Name): STEVEN JOHN BRESSER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W SPRING ST
WAUPUN WI
53963-1046
US

IV. Provider business mailing address

410 W SPRING ST
WAUPUN WI
53963-1046
US

V. Phone/Fax

Practice location:
  • Phone: 920-296-5490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: