MEDICARE: DR. STEFANIE LINETTE ETIENNE MD

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	207Q00000X	Family Medicine Physician	200301458	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	80109621	OTHER		RAILROAD MEDICARE
4	2043012A	OTHER	NC	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	13928	OTHER	BLUE CROSS BLUE SHIELD
2	2547578	OTHER	UNITED HEALTH CARE
5	6216659	OTHER	CIGNA
6	331532	OTHER	WELL PATH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588762686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFANIE LINETTE ETIENNE MD

Provider Business Mailing Address
First Line	:	8222 MARVINO LANE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613
Country	:	US
Telephone Number	:	704-701-1890
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 E DAVIE ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27601-1918
Country	:	US
Telephone Number	:	919-832-2400
Fax Number	:	919-832-5151

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/13/2009

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