Provider Demographics
NPI:1932504339
Name:ELLIOTT, CANDICE M (RN)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15945 MIDDLE POINT RD
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-9769
Mailing Address - Country:US
Mailing Address - Phone:419-968-2351
Mailing Address - Fax:419-968-2227
Practice Address - Street 1:15945 MIDDLE POINT RD
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-9769
Practice Address - Country:US
Practice Address - Phone:419-968-2351
Practice Address - Fax:419-968-2227
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN132988163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool