Provider Demographics
NPI:1396138160
Name:ORTIZ, CANDY M (RN)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:M
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GIRDLER RD
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2205
Mailing Address - Country:US
Mailing Address - Phone:781-910-8628
Mailing Address - Fax:
Practice Address - Street 1:6 GIRDLER RD
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2205
Practice Address - Country:US
Practice Address - Phone:781-910-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN270962163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse