Provider Demographics
NPI:1871062570
Name:ROBERTSON, CONSTANCE GUENETTE
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:GUENETTE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CONSANCE
Other - Middle Name:GUENETTE
Other - Last Name:CANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:912 VINEYARD VINE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7893
Mailing Address - Country:US
Mailing Address - Phone:702-491-5437
Mailing Address - Fax:
Practice Address - Street 1:3050 N JONES BLVD APT 2097
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-6560
Practice Address - Country:US
Practice Address - Phone:702-598-9057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant