Provider Demographics
NPI:1205357811
Name:MICHAUD, CANDY LYNN
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:LYNN
Last Name:MICHAUD
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 1:6 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BRASHER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13613-3149
Mailing Address - Country:US
Mailing Address - Phone:315-212-7177
Mailing Address - Fax:
Practice Address - Street 1:15 4TH ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1340
Practice Address - Country:US
Practice Address - Phone:518-483-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682139-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse