Provider Demographics
NPI:1962523274
Name:CZARNECKI, CONSTANCE F (RSA)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:F
Last Name:CZARNECKI
Suffix:
Gender:F
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WALTERSCHEID BLVD APT 3-101
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2030
Mailing Address - Country:US
Mailing Address - Phone:630-927-8269
Mailing Address - Fax:
Practice Address - Street 1:201 WALTERSCHEID BLVD APT 3-101
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2030
Practice Address - Country:US
Practice Address - Phone:630-927-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZS0410X
IL238.000065246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty