Provider Demographics
NPI:1558121863
Name:TOWNSEND, CANDACE LENORA
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LENORA
Last Name:TOWNSEND
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 1:3434 BELLA VALENCIA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3522
Mailing Address - Country:US
Mailing Address - Phone:702-756-4361
Mailing Address - Fax:
Practice Address - Street 1:3434 BELLA VALENCIA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-3522
Practice Address - Country:US
Practice Address - Phone:702-756-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
NV251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services