Provider Demographics
NPI:1164569554
Name:COLE, CANDICE
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2114
Mailing Address - Country:US
Mailing Address - Phone:785-742-7243
Mailing Address - Fax:
Practice Address - Street 1:304 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2114
Practice Address - Country:US
Practice Address - Phone:785-742-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant