Provider Demographics
NPI:1720017619
Name:DELISIO, CANDACE (CNM)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:DELISIO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3437
Mailing Address - Country:US
Mailing Address - Phone:603-742-0101
Mailing Address - Fax:603-743-3171
Practice Address - Street 1:44 BIRCH ST
Practice Address - Street 2:SUITE 103B
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2752
Practice Address - Country:US
Practice Address - Phone:603-421-2460
Practice Address - Fax:603-421-2479
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0218662301176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH4008816Y0NH01OtherANTHEM
NH30341237Medicaid
NH30341237Medicaid
RE6626Medicare PIN
NHRE662601Medicare PIN
NHP00684102Medicare PIN