Provider Demographics
NPI:1679889133
Name:HARDEEN, DEON CANDACY (BSN RN)
Entity Type:Individual
Prefix:
First Name:DEON
Middle Name:CANDACY
Last Name:HARDEEN
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 KOMONCHAK CIR
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1260
Mailing Address - Country:US
Mailing Address - Phone:845-729-5560
Mailing Address - Fax:
Practice Address - Street 1:70 KOMONCHAK CIR
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1260
Practice Address - Country:US
Practice Address - Phone:845-729-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277893164W00000X
NY847450163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitationGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse