Provider Demographics
NPI:1295792331
Name:OGLINE, CANDICE (RN, APN,C)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:OGLINE
Suffix:
Gender:F
Credentials:RN, APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 MCCLELLAN AVE
Mailing Address - Street 2:LIFE AT LOURDES
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109
Mailing Address - Country:US
Mailing Address - Phone:856-675-3660
Mailing Address - Fax:856-675-3659
Practice Address - Street 1:2475 MCCLELLAN AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4683
Practice Address - Country:US
Practice Address - Phone:856-675-3660
Practice Address - Fax:856-675-3659
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00039200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029475Medicaid
NJ078803Medicare ID - Type Unspecified
NJ0029475Medicaid