Provider Demographics
NPI:1982027835
Name:ESTEVES, CARLY MARISA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:MARISA
Last Name:ESTEVES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-4985
Mailing Address - Country:US
Mailing Address - Phone:845-926-6375
Mailing Address - Fax:
Practice Address - Street 1:1351 ROUTE 55, SUITE 200
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5144
Practice Address - Country:US
Practice Address - Phone:845-475-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR192153363LA2100X
NY430913363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care