Provider Demographics
NPI:1356649461
Name:CONSTABLE, TANYA ROCHELLE
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:ROCHELLE
Last Name:CONSTABLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 N 85TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4209
Mailing Address - Country:US
Mailing Address - Phone:414-379-0076
Mailing Address - Fax:
Practice Address - Street 1:4920 N 85TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4209
Practice Address - Country:US
Practice Address - Phone:414-379-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI281585376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide