Provider Demographics
NPI:1790878197
Name:CHU, CANDACE M (CRNA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:M
Last Name:CHU
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18891 WICKLOW DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-9702
Mailing Address - Country:US
Mailing Address - Phone:312-933-1255
Mailing Address - Fax:
Practice Address - Street 1:1101 W. UNIVERSITY
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48037
Practice Address - Country:US
Practice Address - Phone:248-601-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006803367500000X
MI4704329069367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered