Provider Demographics
NPI:1508022211
Name:CONSTANT, ANGELA SUZANNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SUZANNE
Last Name:CONSTANT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:CONSTANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:433 COUNTY HIGHWAY 553
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-8174
Mailing Address - Country:US
Mailing Address - Phone:573-333-0033
Mailing Address - Fax:
Practice Address - Street 1:108 W 15TH ST
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-2202
Practice Address - Country:US
Practice Address - Phone:573-333-0033
Practice Address - Fax:573-333-2522
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily