Provider Demographics
NPI:1316211386
Name:REGINE, CANDIDA (RN)
Entity Type:Individual
Prefix:MISS
First Name:CANDIDA
Middle Name:
Last Name:REGINE
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 1:455 HUGUENOT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1101
Mailing Address - Country:US
Mailing Address - Phone:718-227-5396
Mailing Address - Fax:
Practice Address - Street 1:455 HUGUENOT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1101
Practice Address - Country:US
Practice Address - Phone:718-227-5396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY416804163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool