Provider Demographics
NPI:1023367190
Name:DE ANDA, ESTELLA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:MARIE
Last Name:DE ANDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ESTELLA
Other - Middle Name:MARIE
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-0865
Mailing Address - Country:US
Mailing Address - Phone:971-244-2972
Mailing Address - Fax:
Practice Address - Street 1:3180 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4592
Practice Address - Country:US
Practice Address - Phone:503-588-5342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079037963RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse