Provider Demographics
NPI:1770862591
Name:ALLEN, CANDIDA L (STNA)
Entity Type:Individual
Prefix:
First Name:CANDIDA
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5233
Mailing Address - Country:US
Mailing Address - Phone:216-235-6286
Mailing Address - Fax:216-916-4137
Practice Address - Street 1:13701 MARTIN DR
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5233
Practice Address - Country:US
Practice Address - Phone:216-235-6286
Practice Address - Fax:216-916-4137
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH377358990598376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide