Provider Demographics
NPI:1932312204
Name:POWERS, CONSTANCE GARDNER
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:GARDNER
Last Name:POWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:LEX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 MONTROSE AVE
Mailing Address - Street 2:UNIT 25
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-525-8522
Mailing Address - Fax:
Practice Address - Street 1:101 N MERION AVE
Practice Address - Street 2:BRYN MAWR COLLEGE
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-526-7360
Practice Address - Fax:610-526-7365
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN275844L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse