Provider Demographics
NPI:1275178477
Name:BISHOP, CANDICE PEHL (LVN)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:PEHL
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:LEIGH
Other - Last Name:PEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8700 CROWNHILL BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1128
Mailing Address - Country:US
Mailing Address - Phone:210-824-5530
Mailing Address - Fax:
Practice Address - Street 1:8700 CROWNHILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1128
Practice Address - Country:US
Practice Address - Phone:210-824-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170825164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170825OtherNURSING LICENCE