Provider Demographics
NPI:1477211696
Name:PRIMOUS, CANDICE (RN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:PRIMOUS
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 1:511 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8173
Mailing Address - Country:US
Mailing Address - Phone:214-562-5300
Mailing Address - Fax:
Practice Address - Street 1:511 PRINCE ST
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-8173
Practice Address - Country:US
Practice Address - Phone:214-562-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX979411163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty