Provider Demographics
NPI:1003107491
Name:PRITTS, CANDICE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:PRITTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69053 BARBINA RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:OH
Mailing Address - Zip Code:43977-9723
Mailing Address - Country:US
Mailing Address - Phone:740-359-0151
Mailing Address - Fax:
Practice Address - Street 1:69053 BARBINA RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:OH
Practice Address - Zip Code:43977-9723
Practice Address - Country:US
Practice Address - Phone:740-359-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.132284IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse