Provider Demographics
NPI:1730422551
Name:MARIO, CONSTANCE M (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:M
Last Name:MARIO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:CONSTANCE
Other - Middle Name:M
Other - Last Name:FERRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:100 EAGLEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19408-0045
Mailing Address - Country:US
Mailing Address - Phone:610-635-7588
Mailing Address - Fax:610-539-0785
Practice Address - Street 1:100 EAGLEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19408-0045
Practice Address - Country:US
Practice Address - Phone:610-635-7588
Practice Address - Fax:610-539-0785
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily