Provider Demographics
NPI:1003823691
Name:ST ETIENNE, ROSELYN
Entity Type:Individual
Prefix:DR
First Name:ROSELYN
Middle Name:
Last Name:ST ETIENNE
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 1:4701 WESTBANK EXPY STE 7
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3050
Mailing Address - Country:US
Mailing Address - Phone:504-582-9922
Mailing Address - Fax:504-582-9928
Practice Address - Street 1:4701 WESTBANK EXPY STE 7
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3050
Practice Address - Country:US
Practice Address - Phone:504-582-9922
Practice Address - Fax:504-582-9928
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12769R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics