Provider Demographics
NPI:1588762686
Name:ETIENNE, STEFANIE LINETTE (MD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:LINETTE
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:LINETTE
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8222 MARVINO LANE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613
Mailing Address - Country:US
Mailing Address - Phone:704-701-1890
Mailing Address - Fax:
Practice Address - Street 1:512 E DAVIE ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1918
Practice Address - Country:US
Practice Address - Phone:919-832-2400
Practice Address - Fax:919-832-5151
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13928OtherBLUE CROSS BLUE SHIELD
2547578OtherUNITED HEALTH CARE
80109621OtherRAILROAD MEDICARE
NC2043012AOtherMEDICARE
6216659OtherCIGNA
331532OtherWELL PATH
NC5902190Medicaid
NC5902190Medicaid
I37403Medicare UPIN