Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 12769R | LA |
NPI | 1003823691 |
---|---|
Provider Name | Dr. Roselyn St Etienne |
First Address | Marrero, LA 70072-3050 |
Second Address | Marrero, LA 70072-3050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 13/01/2022 |