Provider Demographics
NPI:1154016905
Name:ESTEP, ELISSA LAUREN
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:LAUREN
Last Name:ESTEP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 STILLMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3916
Mailing Address - Country:US
Mailing Address - Phone:210-838-8662
Mailing Address - Fax:
Practice Address - Street 1:3903 STILLMEADOW DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3916
Practice Address - Country:US
Practice Address - Phone:210-838-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99511176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty