Provider Demographics
NPI:1376196980
Name:WILLIAMS, CANDACE RENE' (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:RENE'
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:CANDACE
Other - Middle Name:RENE'
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:1902 E ST SW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-8708
Mailing Address - Country:US
Mailing Address - Phone:918-961-0087
Mailing Address - Fax:
Practice Address - Street 1:23701 S 655 RD
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-6317
Practice Address - Country:US
Practice Address - Phone:918-787-5452
Practice Address - Fax:918-517-3265
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0107969163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management