Provider Demographics
NPI:1063170439
Name:ESTANTE, EDWARD A (BSN RN VABC CRNI)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:ESTANTE
Suffix:
Gender:M
Credentials:BSN RN VABC CRNI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 CALDARELLA CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5972
Mailing Address - Country:US
Mailing Address - Phone:916-975-5988
Mailing Address - Fax:916-742-5728
Practice Address - Street 1:484 CALDARELLA CIR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5972
Practice Address - Country:US
Practice Address - Phone:916-975-5988
Practice Address - Fax:916-742-5728
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA628410163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD5828103OtherDRIVER LICENSE