Provider Demographics
NPI:1861950768
Name:STEINKE, ILA
Entity type:Individual
Prefix:
First Name:ILA
Middle Name:
Last Name:STEINKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S9259 COUNTY ROAD V
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WI
Mailing Address - Zip Code:54722
Mailing Address - Country:US
Mailing Address - Phone:715-533-9380
Mailing Address - Fax:
Practice Address - Street 1:S9259 COUNTY ROAD V
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WI
Practice Address - Zip Code:54722
Practice Address - Country:US
Practice Address - Phone:715-533-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIS352-4139-8803-08390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program