Provider Demographics
NPI:1396892501
Name:PASTERNAK, CONSTANCE (NP)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:PASTERNAK
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 1:9 HOMEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1242
Mailing Address - Country:US
Mailing Address - Phone:828-450-0528
Mailing Address - Fax:
Practice Address - Street 1:3803 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2593
Practice Address - Country:US
Practice Address - Phone:828-450-0528
Practice Address - Fax:336-540-6156
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY478896-1163W00000X
NY303539363LA2200X
NY340560363LG0600X
NC244672163W00000X
NC5005141363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02353657Medicaid
NYDD4017Medicare ID - Type Unspecified
NYP77589Medicare UPIN