Provider Demographics
NPI:1467759878
Name:TICE, CANDACE CLEO (RN)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:CLEO
Last Name:TICE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:OH
Mailing Address - Zip Code:44837-1109
Mailing Address - Country:US
Mailing Address - Phone:419-951-4838
Mailing Address - Fax:
Practice Address - Street 1:22 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:OH
Practice Address - Zip Code:44837-1109
Practice Address - Country:US
Practice Address - Phone:419-951-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH267166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse