Healthcare Provider Details

I. General information

NPI: 1184705816
Provider Name (Legal Business Name): SANDRA L ESTEP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 103 SUPPLY STREET
GARY WV
24836
US

IV. Provider business mailing address

HC 60 BOX 355
IAEGER WV
24844-9428
US

V. Phone/Fax

Practice location:
  • Phone: 304-448-2101
  • Fax: 304-448-3217
Mailing address:
  • Phone: 304-938-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341349-22
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: