Provider Demographics
NPI:1265046528
Name:O'DELL, CANDACE ROCHELLE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:ROCHELLE
Last Name:O'DELL
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:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:HENSLEY
Mailing Address - State:WV
Mailing Address - Zip Code:24843-0024
Mailing Address - Country:US
Mailing Address - Phone:304-656-8165
Mailing Address - Fax:
Practice Address - Street 1:138 BLUEBONNETT CIR
Practice Address - Street 2:
Practice Address - City:HENSLEY
Practice Address - State:WV
Practice Address - Zip Code:24843
Practice Address - Country:US
Practice Address - Phone:304-656-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant