Provider Demographics
NPI:1356609754
Name:GAWUM, CONSTANCE N
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:N
Last Name:GAWUM
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 1:1200 HEARTLAND CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-6098
Mailing Address - Country:US
Mailing Address - Phone:301-978-6383
Mailing Address - Fax:
Practice Address - Street 1:1200 HEARTLAND CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-6098
Practice Address - Country:US
Practice Address - Phone:301-978-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1054202163W00000X
DCNP1054202363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDRN1054202OtherDC BOARD OF NURSING