Provider Demographics
NPI:1730319690
Name:BLACK, CANDIES JA'NET (LPN)
Entity Type:Individual
Prefix:
First Name:CANDIES
Middle Name:JA'NET
Last Name:BLACK
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 1:1372 YORKLAND RD
Mailing Address - Street 2:APT A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7480
Mailing Address - Country:US
Mailing Address - Phone:614-517-3055
Mailing Address - Fax:
Practice Address - Street 1:1372 YORKLAND RD
Practice Address - Street 2:APT A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7480
Practice Address - Country:US
Practice Address - Phone:614-517-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN120452164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse