Provider Demographics
NPI:1710404124
Name:PROKOP REED, CANDACE LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LEE
Last Name:PROKOP REED
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 1:3149 RIVER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44010-9761
Mailing Address - Country:US
Mailing Address - Phone:440-275-1824
Mailing Address - Fax:440-275-1855
Practice Address - Street 1:3149 RIVER GLEN DR
Practice Address - Street 2:
Practice Address - City:AUSTINBURG
Practice Address - State:OH
Practice Address - Zip Code:44010-9761
Practice Address - Country:US
Practice Address - Phone:440-275-1824
Practice Address - Fax:440-275-1855
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-296028163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty