Provider Demographics
NPI:1184705816
Name:ESTEP, SANDRA L (FNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:ESTEP
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 60 BOX 355
Mailing Address - Street 2:
Mailing Address - City:IAEGER
Mailing Address - State:WV
Mailing Address - Zip Code:24844-9428
Mailing Address - Country:US
Mailing Address - Phone:304-938-5283
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 103 SUPPLY STREET
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:WV
Practice Address - Zip Code:24836
Practice Address - Country:US
Practice Address - Phone:304-448-2101
Practice Address - Fax:304-448-3217
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV341349-22363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001713997OtherBCBS
WV3810004477Medicaid
WVP00171749OtherMEDICARE RAILROAD
WV3810004477Medicaid
WV2026863Medicare PIN
WV001713997OtherBCBS
WV2026861Medicare PIN