Provider Demographics
NPI:1366435083
Name:ROSENBERG, STEFANIE M (PA)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:M
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W BROWN DEER RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1627
Mailing Address - Country:US
Mailing Address - Phone:414-434-0461
Mailing Address - Fax:414-434-0467
Practice Address - Street 1:500 W BROWN DEER RD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:WI
Practice Address - Zip Code:53217-1627
Practice Address - Country:US
Practice Address - Phone:414-434-0461
Practice Address - Fax:414-434-0467
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63921363A00000X
WI2521-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant