Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F001427-1 | NY |
NPI | 1154629954 |
---|---|
Provider Name | Stephanie Etienne |
First Address | Kerhonkson, NY 12446-2113 |
Second Address | Bronx, NY 10457-7606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2011 |
Last Update Date | 03/03/2011 |