Provider Demographics
NPI:1134523319
Name:CHARRON, CONSTANTINHA
Entity type:Individual
Prefix:MISS
First Name:CONSTANTINHA
Middle Name:
Last Name:CHARRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CONSTANTINHA
Other - Middle Name:
Other - Last Name:FLICKINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:142 MANDY RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:SC
Mailing Address - Zip Code:29039
Mailing Address - Country:US
Mailing Address - Phone:803-542-0638
Mailing Address - Fax:
Practice Address - Street 1:142 MANDY RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:SC
Practice Address - Zip Code:29039
Practice Address - Country:US
Practice Address - Phone:803-542-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2004-0000955163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse