Provider Demographics
NPI:1750029294
Name:CONSTANTIN, OLIVIA LOUISE (LPN)
Entity type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:LOUISE
Last Name:CONSTANTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11527 BEECH TREE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-9516
Mailing Address - Country:US
Mailing Address - Phone:716-913-3407
Mailing Address - Fax:
Practice Address - Street 1:11527 BEECH TREE RD
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-9516
Practice Address - Country:US
Practice Address - Phone:716-913-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336738164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse