Provider Demographics
NPI:1215712534
Name:LAWSAMBA EPSE F MORFAW ATE, CONSTANCE B
Entity type:Individual
Prefix:
First Name:CONSTANCE B
Middle Name:
Last Name:LAWSAMBA EPSE F MORFAW ATE
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 1:2930 BUCKTHORN CT
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-5517
Mailing Address - Country:US
Mailing Address - Phone:571-547-9095
Mailing Address - Fax:
Practice Address - Street 1:2930 BUCKTHORN CT
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-5517
Practice Address - Country:US
Practice Address - Phone:571-547-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant