Provider Demographics
NPI:1568666998
Name:NESBETH, CANDY NATASHA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CANDY
Middle Name:NATASHA
Last Name:NESBETH
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 1:605 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-3037
Mailing Address - Country:US
Mailing Address - Phone:302-250-3189
Mailing Address - Fax:
Practice Address - Street 1:605 W 29TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-3037
Practice Address - Country:US
Practice Address - Phone:302-250-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0009747164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse