Provider Demographics
NPI:1467194480
Name:GREEN, CONSTANCE LAVERNE
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:LAVERNE
Last Name:GREEN
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 1:2942 2ND ST SE # 232515
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1740
Mailing Address - Country:US
Mailing Address - Phone:202-684-0269
Mailing Address - Fax:
Practice Address - Street 1:2942 2ND ST SE # 232515
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1740
Practice Address - Country:US
Practice Address - Phone:202-684-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide