Healthcare Provider Details

I. General information

NPI: 1578492443
Provider Name (Legal Business Name): CONSTANCE DENISE NEVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1478 LONDON AVE
MANTECA CA
95336-7009
US

IV. Provider business mailing address

1555 MAG DUFFY ST
HUMBOLDT TN
38343-5666
US

V. Phone/Fax

Practice location:
  • Phone: 559-799-7977
  • Fax:
Mailing address:
  • Phone: 559-799-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: