Provider Demographics
NPI:1922737311
Name:HARRIS, CANDIDA DAWN
Entity Type:Individual
Prefix:MRS
First Name:CANDIDA
Middle Name:DAWN
Last Name:HARRIS
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 1:18044 STATE ROUTE 335
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OH
Mailing Address - Zip Code:45613-9715
Mailing Address - Country:US
Mailing Address - Phone:740-835-0110
Mailing Address - Fax:
Practice Address - Street 1:223 SAINT ANNS LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1040
Practice Address - Country:US
Practice Address - Phone:740-835-6608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant