Provider Demographics
NPI:1376702746
Name:YOUNG, CANDICE SHELBY (RN BSN PHN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:SHELBY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN BSN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 CENTER AVE
Mailing Address - Street 2:SUIT 150
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4640
Mailing Address - Country:US
Mailing Address - Phone:510-207-3735
Mailing Address - Fax:
Practice Address - Street 1:597 CENTER AVE
Practice Address - Street 2:SUIT 150
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4640
Practice Address - Country:US
Practice Address - Phone:510-207-3735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA688902163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management