Provider Demographics
NPI:1740606060
Name:HOWARD, CANDACE (LPN)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:HOWARD
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 1:20170 FULLER AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2635
Mailing Address - Country:US
Mailing Address - Phone:216-331-9660
Mailing Address - Fax:
Practice Address - Street 1:20170 FULLER AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2635
Practice Address - Country:US
Practice Address - Phone:216-331-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
132700000X
OHPN112217164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager
No164W00000XNursing Service ProvidersLicensed Practical Nurse