Provider Demographics
NPI:1801078340
Name:VACCAREZZA, CONSTANCE MARIE (PHN)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:MARIE
Last Name:VACCAREZZA
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 S BURSON RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-8909
Mailing Address - Country:US
Mailing Address - Phone:209-772-3192
Mailing Address - Fax:
Practice Address - Street 1:6421 S BURSON RD
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-8909
Practice Address - Country:US
Practice Address - Phone:209-772-3192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384667163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health