Provider Demographics
NPI:1265848923
Name:GOTTMAN, CANDICE RENEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:RENEE
Last Name:GOTTMAN
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 1:3105 RT. W
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2203
Mailing Address - Country:US
Mailing Address - Phone:573-221-1166
Mailing Address - Fax:573-221-1214
Practice Address - Street 1:3105 RT. W
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2203
Practice Address - Country:US
Practice Address - Phone:573-221-1166
Practice Address - Fax:573-221-1214
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008342163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse