Provider Demographics
NPI:1942949276
Name:ACKMAN, CANDIE
Entity Type:Individual
Prefix:
First Name:CANDIE
Middle Name:
Last Name:ACKMAN
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 1:2901 STATE ROUTE 262
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:IN
Mailing Address - Zip Code:47040-9161
Mailing Address - Country:US
Mailing Address - Phone:513-473-5342
Mailing Address - Fax:
Practice Address - Street 1:2901 STATE ROUTE 262
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:IN
Practice Address - Zip Code:47040-9161
Practice Address - Country:US
Practice Address - Phone:513-473-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.483051364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care