Provider Demographics
NPI:1669511044
Name:WASHINGTON, CANDICE LOUISE (LPN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:LOUISE
Last Name:WASHINGTON
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 1:16011 ELBROOK ST NE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-1405
Mailing Address - Country:US
Mailing Address - Phone:330-823-5895
Mailing Address - Fax:
Practice Address - Street 1:16011 ELBROOK ST NE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-1405
Practice Address - Country:US
Practice Address - Phone:330-823-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH25206164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse