Provider Demographics
NPI:1265160873
Name:CANDELO, NALLYVE (RN IBCLC)
Entity type:Individual
Prefix:
First Name:NALLYVE
Middle Name:
Last Name:CANDELO
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 N LOVEJOY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1214
Mailing Address - Country:US
Mailing Address - Phone:773-942-3702
Mailing Address - Fax:
Practice Address - Street 1:5400 N LOVEJOY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1214
Practice Address - Country:US
Practice Address - Phone:773-942-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041389658163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant