Provider Demographics
NPI:1609387380
Name:ESTEVANES, DEZERAE (LVN)
Entity Type:Individual
Prefix:
First Name:DEZERAE
Middle Name:
Last Name:ESTEVANES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 N WESTGATE DR APT 5307
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-0180
Mailing Address - Country:US
Mailing Address - Phone:956-249-9117
Mailing Address - Fax:
Practice Address - Street 1:3600 N WESTGATE DR APT 5307
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78599-0180
Practice Address - Country:US
Practice Address - Phone:956-249-9117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331418164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse