Provider Demographics
NPI:1154778462
Name:CONSTANCE, ANN CHRISTINE (MA, RDN, CDE, FAADE)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:CHRISTINE
Last Name:CONSTANCE
Suffix:
Gender:F
Credentials:MA, RDN, CDE, FAADE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 S LAKESHORE BLVD
Mailing Address - Street 2:#8
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4632
Mailing Address - Country:US
Mailing Address - Phone:906-361-9754
Mailing Address - Fax:
Practice Address - Street 1:518 S LAKESHORE BLVD
Practice Address - Street 2:#8
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4632
Practice Address - Country:US
Practice Address - Phone:906-361-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI806543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered