Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01071245A | IN |
Y | 2080P0203X | Pediatric Critical Care Doctor | 01071245A | IN |
NPI | 1063631141 |
---|---|
Provider Name | Michelle Renee Estep |
First Address | Evansville, IN 47733-3407 |
Second Address | Newburgh, IN 47630-8947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 12/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02527537 | (05) | MS |
302I816382 | MEDICARE PTAN (01) | MS |