Provider Demographics
NPI:1114905122
Name:CRISWELL, CONSTANCE SUSAN (CRNA)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:SUSAN
Last Name:CRISWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:SUSAN
Other - Last Name:DRUMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1 MADRONE ST
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-4225
Mailing Address - Country:US
Mailing Address - Phone:707-456-3171
Mailing Address - Fax:
Practice Address - Street 1:1 MADRONE ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4225
Practice Address - Country:US
Practice Address - Phone:707-456-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3189367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered