Provider Demographics
NPI:1114745775
Name:CONSTANT, KATIANA
Entity type:Individual
Prefix:
First Name:KATIANA
Middle Name:
Last Name:CONSTANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CARL AVE APT E140
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-4358
Mailing Address - Country:US
Mailing Address - Phone:857-384-8485
Mailing Address - Fax:
Practice Address - Street 1:165 CARL AVE APT E140
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-4358
Practice Address - Country:US
Practice Address - Phone:857-384-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula