Provider Demographics
NPI:1164295549
Name:DADA, CONSTANCE SUE (RN)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:SUE
Last Name:DADA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 NE 23RD ST UNIT C8
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4824
Mailing Address - Country:US
Mailing Address - Phone:564-653-5823
Mailing Address - Fax:
Practice Address - Street 1:2621 NE 134TH ST STE 140
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3036
Practice Address - Country:US
Practice Address - Phone:360-504-0122
Practice Address - Fax:360-859-1354
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61363362163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator