Provider Demographics
NPI:1740691096
Name:ESTEP, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:ESTEP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT# 42065 PO BOX 650823
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-6662
Mailing Address - Country:US
Mailing Address - Phone:602-200-9021
Mailing Address - Fax:
Practice Address - Street 1:550 W MARYLAND AVE UNIT 123
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1363
Practice Address - Country:US
Practice Address - Phone:816-262-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN187379163W00000X
AZCRNA1052367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse