Provider Demographics
NPI:1629285937
Name:CONSTABLE, ANGELINA JEANINE
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:JEANINE
Last Name:CONSTABLE
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 1:1227 SCHOOL ST NW APT 204
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1885
Mailing Address - Country:US
Mailing Address - Phone:763-227-6100
Mailing Address - Fax:
Practice Address - Street 1:14500 99TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4478
Practice Address - Country:US
Practice Address - Phone:763-898-1361
Practice Address - Fax:763-898-1866
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter