Provider Demographics
NPI:1447432323
Name:POWE-WATTS, CONSTANCE THRESA (MS, CNM)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:THRESA
Last Name:POWE-WATTS
Suffix:
Gender:F
Credentials:MS, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-253-3910
Mailing Address - Fax:517-253-3911
Practice Address - Street 1:1540 LAKE LANSING RD 205
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3757
Practice Address - Country:US
Practice Address - Phone:517-523-3910
Practice Address - Fax:517-523-3911
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704128525367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife