Healthcare Provider Details

I. General information

NPI: 1508269952
Provider Name (Legal Business Name): CONSTANCE SHEETS DNP, RN, GCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9003 W 200 S
LA PORTE IN
46350-9503
US

IV. Provider business mailing address

836 LA PORTE AVE LEBIEN HALL ROOM #6
VALPARAISO IN
46383
US

V. Phone/Fax

Practice location:
  • Phone: 219-785-4194
  • Fax:
Mailing address:
  • Phone: 218-464-5297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number28118004A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: