Provider Demographics
NPI:1326822149
Name:BAILEY, CANDICE LATICIA (LPN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:LATICIA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:LATICIA
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:143 WISHING VIEW DR APT D
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3158
Mailing Address - Country:US
Mailing Address - Phone:585-465-1961
Mailing Address - Fax:
Practice Address - Street 1:143 WISHING VIEW DR APT D
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-3158
Practice Address - Country:US
Practice Address - Phone:585-465-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343699-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse