Provider Demographics
NPI:1013924273
Name:GILLETT, CONSTANCE MARY (NP)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:MARY
Last Name:GILLETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HANOVER ST
Mailing Address - Street 2:STE 1E
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5444
Mailing Address - Country:US
Mailing Address - Phone:508-679-7770
Mailing Address - Fax:508-679-7786
Practice Address - Street 1:300 HANOVER ST
Practice Address - Street 2:STE 1E
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5444
Practice Address - Country:US
Practice Address - Phone:508-679-7770
Practice Address - Fax:508-679-7786
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151235363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2476OtherMA BCBS
0000022917OtherBCBS RI
RI410546OtherBLUECHIP
MA0376311Medicaid
MANP2476OtherMA BCBS
MANP2476Medicare ID - Type Unspecified