Provider Demographics
NPI:1609810100
Name:COX, CONSTANCE M (CRNA)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:M
Last Name:COX
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-8527
Mailing Address - Country:US
Mailing Address - Phone:937-308-5407
Mailing Address - Fax:
Practice Address - Street 1:75 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3237
Practice Address - Country:US
Practice Address - Phone:937-320-5050
Practice Address - Fax:937-320-5060
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.07366-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2476904Medicaid
OHH188530Medicare PIN