Provider Demographics
NPI:1174130066
Name:KIDD, CONSTANCE NADINE
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:NADINE
Last Name:KIDD
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 1:492 LYTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-1210
Mailing Address - Country:US
Mailing Address - Phone:513-724-3044
Mailing Address - Fax:
Practice Address - Street 1:492 LYTLE AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-1210
Practice Address - Country:US
Practice Address - Phone:151-372-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant