Provider Demographics
NPI:1457011249
Name:GMEHLIN, MARIA GRACIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GRACIA
Last Name:GMEHLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:GRACIA
Other - Last Name:ROJAS INFANTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:13111 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-2416
Mailing Address - Country:US
Mailing Address - Phone:262-243-2500
Mailing Address - Fax:
Practice Address - Street 1:13133 N PORT WASHINGTON RD STE G16
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2423
Practice Address - Country:US
Practice Address - Phone:262-243-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5578-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant