Provider Demographics
NPI:1649993353
Name:GENDA, CANDACE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:GENDA
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 1:548 S CRIMSON CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-8953
Mailing Address - Country:US
Mailing Address - Phone:317-446-2392
Mailing Address - Fax:
Practice Address - Street 1:548 S CRIMSON CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-8953
Practice Address - Country:US
Practice Address - Phone:317-446-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28071863C163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management