Provider Demographics
NPI:1134390768
Name:FETTERS, CONSTANCE MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:MARIE
Last Name:FETTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CONSTANCE
Other - Middle Name:MARIE
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1080 LA QUINTA ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4809
Mailing Address - Country:US
Mailing Address - Phone:575-312-5695
Mailing Address - Fax:
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2917
Practice Address - Country:US
Practice Address - Phone:575-312-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR10382163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse