=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154550127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONSTANCE DEFREEST M.S., N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2009
-----------------------------------------------------
Last Update Date | 12/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1285 ROUTE 9 SUITE 7B
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-4993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-632-2939
-----------------------------------------------------
Fax | 845-632-2940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1285 ROUTE 9 SUITE 7B
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-4993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-632-2939
-----------------------------------------------------
Fax | 845-632-2940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | F400718-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------