Provider Demographics
NPI:1417543794
Name:CRAIG, CANDACE K
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:K
Last Name:CRAIG
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 1:4949 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-5860
Mailing Address - Country:US
Mailing Address - Phone:440-478-6683
Mailing Address - Fax:
Practice Address - Street 1:4949 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-5860
Practice Address - Country:US
Practice Address - Phone:440-478-6683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker