Provider Demographics
NPI:1568638468
Name:CONSTANCE M FETTERS
Entity Type:Organization
Organization Name:CONSTANCE M FETTERS
Other - Org Name:DESERT DIABETES RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FETTERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN CDE
Authorized Official - Phone:575-541-4451
Mailing Address - Street 1:1080 LA QUINTA ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4809
Mailing Address - Country:US
Mailing Address - Phone:575-541-4451
Mailing Address - Fax:575-524-1454
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2917
Practice Address - Country:US
Practice Address - Phone:575-541-4451
Practice Address - Fax:575-524-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR10382251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)