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General NPI Number Information
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NPI Number | 1588762686
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Entity Type | Individual
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Provider Name | STEFANIE LINETTE ETIENNE MD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 512 E DAVIE ST
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City | RALEIGH
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State | NC
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Zip | 27601-1918
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Country | US
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Telephone | 919-832-2400
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Fax | 919-832-5151
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Provider Business Mailing Address
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Address Line | 8222 MARVINO LANE
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City | RALEIGH
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State | NC
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Zip | 27613
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Country | US
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Telephone | 704-701-1890
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200301458
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License Number State | NC
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