Provider Demographics
NPI:1598428088
Name:WASHINGTON, CANDY NICOLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:NICOLE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 GENOA WAY APT 408
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-7016
Mailing Address - Country:US
Mailing Address - Phone:205-331-6383
Mailing Address - Fax:
Practice Address - Street 1:2520 GENOA WAY APT 408
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-7016
Practice Address - Country:US
Practice Address - Phone:205-331-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-104030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty