Provider Demographics
NPI:1811271034
Name:LOPEZ, CONSTANCE ROSALIE (RN)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ROSALIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ACADEMY ST
Mailing Address - Street 2:HEALTH OFFICE
Mailing Address - City:PINE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12567-5603
Mailing Address - Country:US
Mailing Address - Phone:518-398-3000
Mailing Address - Fax:518-398-1141
Practice Address - Street 1:41 ACADEMY ST
Practice Address - Street 2:HEALTH OFFICE
Practice Address - City:PINE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12567-5603
Practice Address - Country:US
Practice Address - Phone:518-398-3000
Practice Address - Fax:518-398-1141
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276694-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse