Provider Demographics
NPI:1619619061
Name:HEROD, KANDUS (LVN)
Entity Type:Individual
Prefix:
First Name:KANDUS
Middle Name:
Last Name:HEROD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N ST UNIT 506
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-4330
Mailing Address - Country:US
Mailing Address - Phone:916-205-7836
Mailing Address - Fax:
Practice Address - Street 1:500 N ST UNIT 506
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-4330
Practice Address - Country:US
Practice Address - Phone:916-205-7836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA187163164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse