Provider Demographics
NPI:1245583947
Name:SIDBERRY, CONSTANCE (LPN)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:SIDBERRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 W 165TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4329
Mailing Address - Country:US
Mailing Address - Phone:713-517-4949
Mailing Address - Fax:
Practice Address - Street 1:476 W 165TH ST APT 3B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4329
Practice Address - Country:US
Practice Address - Phone:713-517-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066961164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse