Healthcare Provider Details

I. General information

NPI: 1346449543
Provider Name (Legal Business Name): NATIVIDA ETIENNE-MAULE DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATIVIDA CHAPMAN FNP-BC

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25410 INTERSTATE 45 N
SPRING TX
77386-1351
US

IV. Provider business mailing address

25410 INTERSTATE 45 N
SPRING TX
77386-1351
US

V. Phone/Fax

Practice location:
  • Phone: 281-367-1414
  • Fax: 281-383-5686
Mailing address:
  • Phone: 281-367-1414
  • Fax: 281-383-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168277
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP124126
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: