Provider Demographics
NPI:1780177170
Name:CONSTANTINE, DENITRA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:DENITRA
Middle Name:
Last Name:CONSTANTINE
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HEYMANN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2322
Mailing Address - Country:US
Mailing Address - Phone:337-504-4279
Mailing Address - Fax:337-504-4692
Practice Address - Street 1:1615 N 51ST ST APT 511
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6103
Practice Address - Country:US
Practice Address - Phone:337-515-7139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61665524363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health