Provider Demographics
NPI:1437653557
Name:STEINBACHER, KELLE RAE
Entity Type:Individual
Prefix:
First Name:KELLE
Middle Name:RAE
Last Name:STEINBACHER
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 1:2300 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-4004
Mailing Address - Country:US
Mailing Address - Phone:570-980-9410
Mailing Address - Fax:
Practice Address - Street 1:2300 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-4004
Practice Address - Country:US
Practice Address - Phone:570-980-9410
Practice Address - Fax:570-980-9770
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily