Provider Demographics
NPI:1407631542
Name:HOLLAND, CANDICE S
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:S
Last Name:HOLLAND
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 1:26045 REGENCY CLUB DR APT 3
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-6234
Mailing Address - Country:US
Mailing Address - Phone:313-701-2778
Mailing Address - Fax:
Practice Address - Street 1:26045 REGENCY CLUB DR APT 3
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-6234
Practice Address - Country:US
Practice Address - Phone:313-701-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide