Basic Information
| Provider Information | |||||||||
| NPI: | 1427367465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIFORTE-BLANCKE | ||||||||
| FirstName: | CONSTANCE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8620 18TH AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112143702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182568818 | ||||||||
| FaxNumber: | 7182342314 | ||||||||
| Practice Location | |||||||||
| Address1: | 8620 18TH AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112143702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182568818 | ||||||||
| FaxNumber: | 7182342314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2010 | ||||||||
| LastUpdateDate: | 09/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 324468-1 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.