Provider Demographics
NPI:1366707820
Name:DENHAM, CONSTANCE PITTS (RN,CRNFAFIRST)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:PITTS
Last Name:DENHAM
Suffix:
Gender:F
Credentials:RN,CRNFAFIRST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3928 HARROWSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3561
Mailing Address - Country:US
Mailing Address - Phone:410-270-1254
Mailing Address - Fax:
Practice Address - Street 1:2655 NORTHWINDS PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2280
Practice Address - Country:US
Practice Address - Phone:678-690-8334
Practice Address - Fax:404-751-5294
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN177924163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse