Provider Demographics
NPI:1295194488
Name:BARONE, CANDACE JOHANNA (RN)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:JOHANNA
Last Name:BARONE
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 1:2506 E BELTLINE
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2302
Mailing Address - Country:US
Mailing Address - Phone:218-263-9000
Mailing Address - Fax:218-263-8336
Practice Address - Street 1:2506 E BELTLINE
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2302
Practice Address - Country:US
Practice Address - Phone:218-263-9000
Practice Address - Fax:218-263-8336
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR166142-23747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA709430000Medicaid