Provider Demographics
NPI:1134579246
Name:MCCLAIN, CANDICE NICOLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:NICOLE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:CANDICE
Other - Middle Name:NICOLE
Other - Last Name:CLELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33021 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-1800
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:33021 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-1800
Practice Address - Country:US
Practice Address - Phone:866-389-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704278998163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse