Provider Demographics
NPI:1124358718
Name:CLEMENTS, CANDICE (LVN)
Entity Type:Individual
Prefix:MISS
First Name:CANDICE
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 HIGHWAY 156 UNIT 22
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95012-2928
Mailing Address - Country:US
Mailing Address - Phone:530-249-2943
Mailing Address - Fax:
Practice Address - Street 1:1083 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2323
Practice Address - Country:US
Practice Address - Phone:831-424-5838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN222464164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse