Provider Demographics
NPI:1356048938
Name:DUVERGE, CANDIDA R (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:CANDIDA
Middle Name:R
Last Name:DUVERGE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SENECA AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10474-4624
Mailing Address - Country:US
Mailing Address - Phone:929-217-7916
Mailing Address - Fax:
Practice Address - Street 1:1200 SENECA AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-4624
Practice Address - Country:US
Practice Address - Phone:929-217-7916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592131163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty