Provider Demographics
NPI:1669036166
Name:MCINTYRE, CANDICE LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:LEE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4084 STATE ROUTE 69
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-3380
Mailing Address - Country:US
Mailing Address - Phone:315-806-7268
Mailing Address - Fax:
Practice Address - Street 1:4084 STATE ROUTE 69
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-3380
Practice Address - Country:US
Practice Address - Phone:315-806-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606474163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice