Provider Demographics
NPI:1437993920
Name:NKWANTAH, CONSTANCE ATABONG
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:ATABONG
Last Name:NKWANTAH
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 1:46 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-3267
Mailing Address - Country:US
Mailing Address - Phone:781-526-1871
Mailing Address - Fax:
Practice Address - Street 1:46 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3267
Practice Address - Country:US
Practice Address - Phone:781-526-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2024012045363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health