Provider Demographics
NPI:1083329973
Name:WARREN-CANNON, KANDICE SHANA (LVN)
Entity Type:Individual
Prefix:
First Name:KANDICE
Middle Name:SHANA
Last Name:WARREN-CANNON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:KANDICE
Other - Middle Name:SHANA
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1616 W AVENUE L
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-6247
Mailing Address - Country:US
Mailing Address - Phone:877-734-2244
Mailing Address - Fax:
Practice Address - Street 1:1616 W AVENUE L
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6247
Practice Address - Country:US
Practice Address - Phone:877-734-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN197412164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB6702778OtherDRIVER LICENSE