Provider Demographics
NPI:1396758934
Name:ESTALA, STEPHANIE M (DNP, RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:ESTALA
Suffix:
Gender:F
Credentials:DNP, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SMITH ST
Mailing Address - Street 2:RM 03177
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-7327
Mailing Address - Country:US
Mailing Address - Phone:713-372-5923
Mailing Address - Fax:713-372-5941
Practice Address - Street 1:1400 SMITH ST
Practice Address - Street 2:RM 03177
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-7327
Practice Address - Country:US
Practice Address - Phone:713-372-5923
Practice Address - Fax:713-372-5941
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q08471Medicare UPIN