Provider Demographics
NPI:1396467379
Name:DAWSON, CANDICE LORRAINE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:LORRAINE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 DORSEY LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-7076
Mailing Address - Country:US
Mailing Address - Phone:681-285-9567
Mailing Address - Fax:
Practice Address - Street 1:1205 DORSEY LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-7076
Practice Address - Country:US
Practice Address - Phone:681-285-9567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant