Provider Demographics
NPI:1497026512
Name:DIERCKS, CANDACE LEE
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LEE
Last Name:DIERCKS
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 1:1844 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4546
Mailing Address - Country:US
Mailing Address - Phone:319-235-5999
Mailing Address - Fax:
Practice Address - Street 1:1844 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4546
Practice Address - Country:US
Practice Address - Phone:319-235-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker