Provider Demographics
NPI:1033988035
Name:PATTON, CANDACE GABRIELLE (CNA)
Entity Type:Individual
Prefix:MISS
First Name:CANDACE
Middle Name:GABRIELLE
Last Name:PATTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17610 STEEL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1446
Mailing Address - Country:US
Mailing Address - Phone:131-346-3873
Mailing Address - Fax:
Practice Address - Street 1:17610 STEEL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1446
Practice Address - Country:US
Practice Address - Phone:313-346-3873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI12312023811834376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide