Provider Demographics
NPI:1346449543
Name:ETIENNE-MAULE, NATIVIDA (DNP, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NATIVIDA
Middle Name:
Last Name:ETIENNE-MAULE
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:MS
Other - First Name:NATIVIDA
Other - Middle Name:
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:25410 INTERSTATE 45 N
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1351
Mailing Address - Country:US
Mailing Address - Phone:281-367-1414
Mailing Address - Fax:281-383-5686
Practice Address - Street 1:25410 INTERSTATE 45 N
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1351
Practice Address - Country:US
Practice Address - Phone:281-367-1414
Practice Address - Fax:281-383-5686
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168277363LF0000X
TXAP124126363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346449543Medicaid
VA498906Medicare Oscar/Certification
VA022464C15Medicare PIN
VA022465C59Medicare PIN
VA493833Medicare Oscar/Certification
VA493869Medicare Oscar/Certification