Basic Information
| Provider Information | |||||||||
| NPI: | 1669614574 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER-FACENDA | ||||||||
| FirstName: | CONSTANCE ANNE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | RN, CSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3532 WINDING WAY | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190733608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103537743 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2250 HICKORY RD STE 240 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194622225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108341122 | ||||||||
| FaxNumber: | 6108347525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2009 | ||||||||
| LastUpdateDate: | 03/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | RN259400L | PA | Y | Nursing Service Providers | Registered Nurse | Community Health | 163WS0200X | 07627518 | PA | N | Nursing Service Providers | Registered Nurse | School |
No ID Information.