Provider Demographics
NPI:1366628315
Name:ESTEP, ERICA J (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:ESTEP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3685 N 129TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164
Practice Address - Country:US
Practice Address - Phone:402-595-3993
Practice Address - Fax:402-595-1132
Is Sole Proprietor?:No
Enumeration Date:2008-01-20
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001359A363A00000X
NE2169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000755693OtherBCBS MEMORIAL HOSPITALIST
INP01154064OtherRR MEDICARE
IN000000755693OtherBCBS MEMORIAL HOSPITALIST
OK00032Medicare PIN