Provider Demographics
NPI:1407724834
Name:GAUSE, CANDICE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:GAUSE
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 1:126 MILFORD ST APT 10
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1804
Mailing Address - Country:US
Mailing Address - Phone:585-490-5553
Mailing Address - Fax:
Practice Address - Street 1:126 MILFORD ST APT 10
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1804
Practice Address - Country:US
Practice Address - Phone:585-490-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY354139164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse