Provider Demographics
NPI:1346837697
Name:TOLIVER, CANDY THERESA (OWNER)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:THERESA
Last Name:TOLIVER
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 WELSH RD APT 412
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-3216
Mailing Address - Country:US
Mailing Address - Phone:267-752-4118
Mailing Address - Fax:
Practice Address - Street 1:2555 WELSH RD APT 412
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-3216
Practice Address - Country:US
Practice Address - Phone:267-752-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care