Provider Demographics
NPI:1477313286
Name:PHIPPS, CANDICE RENEE (RN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:RENEE
Last Name:PHIPPS
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 1:601 ALBANY ST UNIT 305
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2790
Mailing Address - Country:US
Mailing Address - Phone:210-966-3981
Mailing Address - Fax:
Practice Address - Street 1:601 ALBANY ST UNIT 305
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2790
Practice Address - Country:US
Practice Address - Phone:210-966-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2347243163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse