Provider Demographics
NPI:1770045148
Name:BIRDINE, CANDACE ROCHELLE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:ROCHELLE
Last Name:BIRDINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 WOODALE LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-3840
Mailing Address - Country:US
Mailing Address - Phone:615-961-8217
Mailing Address - Fax:
Practice Address - Street 1:2415 WOODALE LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-3840
Practice Address - Country:US
Practice Address - Phone:615-961-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker