Provider Demographics
NPI:1518360858
Name:DANIEL, JOY CANDACE (LPN)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:CANDACE
Last Name:DANIEL
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 1:2386 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7917
Mailing Address - Country:US
Mailing Address - Phone:937-432-9201
Mailing Address - Fax:937-293-5566
Practice Address - Street 1:1161 LYONS RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1857
Practice Address - Country:US
Practice Address - Phone:937-432-9201
Practice Address - Fax:937-293-5566
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.139021-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse