Provider Demographics
NPI:1326690819
Name:AUTISSIER, ESTELLE MARIE (AGACNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:ESTELLE
Middle Name:MARIE
Last Name:AUTISSIER
Suffix:
Gender:F
Credentials:AGACNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-0527
Mailing Address - Fax:212-305-6891
Practice Address - Street 1:161 FORT WASHINGTON AVE FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-0527
Practice Address - Fax:212-305-6891
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431506363LA2100X
NY739695163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse