Provider Demographics
NPI:1942708078
Name:CONSTANCIO, YVONNE (LAC)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:CONSTANCIO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 GALLATIN PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-3743
Mailing Address - Country:US
Mailing Address - Phone:615-485-2105
Mailing Address - Fax:
Practice Address - Street 1:2623 GALLATIN PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-3743
Practice Address - Country:US
Practice Address - Phone:615-485-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN233171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist