Provider Demographics
NPI:1477825552
Name:SCHMIDT, CANDICE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 761
Mailing Address - Street 2:
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972-0761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 HOWELL PLACE
Practice Address - Street 2:
Practice Address - City:SPEONK
Practice Address - State:NY
Practice Address - Zip Code:11972-0761
Practice Address - Country:US
Practice Address - Phone:631-903-3929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301915-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse