Healthcare Provider Details

I. General information

NPI: 1821128851
Provider Name (Legal Business Name): CONSTANCE SHANNON PFINGSTAG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 LINDELL BLVD FL 2
SAINT LOUIS MO
63108-3739
US

IV. Provider business mailing address

1200 KENNEDY DR STE 2032
KEY WEST FL
33040-4023
US

V. Phone/Fax

Practice location:
  • Phone: 914-919-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP04601
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN110834
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number831070
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP123461
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR885174
License Number StateMS
# 6
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11034140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: