Provider Demographics
NPI:1679973895
Name:SMITH, CANDICE (NP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DEPOT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-1856
Mailing Address - Country:US
Mailing Address - Phone:413-743-1080
Mailing Address - Fax:
Practice Address - Street 1:19 DEPOT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1856
Practice Address - Country:US
Practice Address - Phone:413-743-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN257917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily