Healthcare Provider Details

I. General information

NPI: 1376613174
Provider Name (Legal Business Name): CONSTANCE ELIZABETH COREY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT CG-1122 2100 2ND ST SW US COAST GUARD SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

COMDT CG-1122 2100 2ND ST SW US COAST GUARD SUITE 5314
WASHINGTON DC
20593-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-372-4104
  • Fax:
Mailing address:
  • Phone: 202-372-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: