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General NPI Number Information
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NPI Number | 1154629954
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Entity Type | Individual
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Provider Name | STEPHANIE ETIENNE CNM
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Gender | Female
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 1650 GRAND CONCOURSE
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City | BRONX
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State | NY
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Zip | 10457-7606
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Country | US
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Telephone | 718-915-5633
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Fax |
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Provider Business Mailing Address
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Address Line | 41 HICKORY HL
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City | KERHONKSON
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State | NY
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Zip | 12446-2113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | F001427-1
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License Number State | NY
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