Provider Demographics
NPI:1619681566
Name:DRURY, CANDICE LEA (FNP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:LEA
Last Name:DRURY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 N TIPSICO LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2319
Mailing Address - Country:US
Mailing Address - Phone:810-629-5738
Mailing Address - Fax:
Practice Address - Street 1:3075 N TIPSICO LAKE RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2319
Practice Address - Country:US
Practice Address - Phone:810-629-5738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704327000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily