Healthcare Provider Details

I. General information

NPI: 1710900071
Provider Name (Legal Business Name): CONSTANCE HUSMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 W MASON ST
GREEN BAY WI
54303-2022
US

IV. Provider business mailing address

1201 MAIN STREET
OCONTO WI
54153
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-1350
  • Fax: 920-430-1360
Mailing address:
  • Phone: 410-706-5181
  • Fax: 410-706-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6338-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number6338-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: