Provider Demographics
NPI:1407216005
Name:EDWARDS, CANDICE
Entity Type:Individual
Prefix:MISS
First Name:CANDICE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 S RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3242
Mailing Address - Country:US
Mailing Address - Phone:614-598-2771
Mailing Address - Fax:614-928-9289
Practice Address - Street 1:137 S RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-3242
Practice Address - Country:US
Practice Address - Phone:614-598-2771
Practice Address - Fax:614-928-9289
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant