Provider Demographics
NPI:1235461245
Name:BROWN-MANN, CANDICE A (RN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:A
Last Name:BROWN-MANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3704
Mailing Address - Country:US
Mailing Address - Phone:917-500-4317
Mailing Address - Fax:
Practice Address - Street 1:1682 E 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3704
Practice Address - Country:US
Practice Address - Phone:917-500-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY621009163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse