Provider Demographics
NPI:1821128851
Name:PFINGSTAG, CONSTANCE SHANNON (CNM)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:SHANNON
Last Name:PFINGSTAG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4636 S CLAIBORNE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-5010
Practice Address - Country:US
Practice Address - Phone:504-589-7092
Practice Address - Fax:404-494-7435
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX831070163W00000X
LARN110834163W00000X
MSR885174367A00000X
TXAP123461367A00000X
LAAP04601367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04786741Medicaid
TX3300493-01Medicaid
LA1456535Medicaid
LA1456535Medicaid