MEDICARE: MRS. NATIVIDA ETIENNE-MAULE DNP, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024168277	VA
2	363LP2300X	Primary Care Nurse Practitioner	AP124126	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346449543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATIVIDA ETIENNE-MAULE DNP, FNP-BC

Provider Business Mailing Address
First Line	:	25410 INTERSTATE 45 N
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1351
Country	:	US
Telephone Number	:	281-367-1414
Fax Number	:	281-383-5686

Provider Business Practice Location Address
First Line	:	25410 INTERSTATE 45 N
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1351
Country	:	US
Telephone Number	:	281-367-1414
Fax Number	:	281-383-5686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	02/07/2017

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