Provider Demographics
NPI:1306004023
Name:HURT, CANDACE CANADA (CNA)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:CANADA
Last Name:HURT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-3752
Mailing Address - Country:US
Mailing Address - Phone:434-845-1652
Mailing Address - Fax:
Practice Address - Street 1:117 NORMAN DR
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-3752
Practice Address - Country:US
Practice Address - Phone:434-845-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401034383376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide