Provider Demographics
NPI:1275371742
Name:REID, CONSTANCE DELORES
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:DELORES
Last Name:REID
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 1:5124 SPAULDING ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3067
Mailing Address - Country:US
Mailing Address - Phone:531-495-7749
Mailing Address - Fax:
Practice Address - Street 1:5124 SPAULDING ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3067
Practice Address - Country:US
Practice Address - Phone:531-495-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty