Provider Demographics
NPI:1235379306
Name:LOGAN, CONSTANCE JOY (RN)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:JOY
Last Name:LOGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CONSTANCE
Other - Middle Name:JOY
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5973 HOLMES HILL RD
Mailing Address - Street 2:
Mailing Address - City:CONESUS
Mailing Address - State:NY
Mailing Address - Zip Code:14435-9725
Mailing Address - Country:US
Mailing Address - Phone:585-346-0042
Mailing Address - Fax:
Practice Address - Street 1:5973 HOLMES HILL RD
Practice Address - Street 2:
Practice Address - City:CONESUS
Practice Address - State:NY
Practice Address - Zip Code:14435-9725
Practice Address - Country:US
Practice Address - Phone:585-346-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255704-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health