Provider Demographics
NPI:1265209159
Name:MORI, CANDACE L (PHD, APRN)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:L
Last Name:MORI
Suffix:
Gender:F
Credentials:PHD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SKYVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9070
Mailing Address - Country:US
Mailing Address - Phone:330-201-1751
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:330-201-1751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14153163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator