Provider Demographics
NPI:1669771481
Name:HURLEY, CANDACE-DAWN V (RN, APRN, FNP-C,NP-C)
Entity type:Individual
Prefix:
First Name:CANDACE-DAWN
Middle Name:V
Last Name:HURLEY
Suffix:
Gender:F
Credentials:RN, APRN, FNP-C,NP-C
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, APRN, FNP-C,NP-C
Mailing Address - Street 1:615 MILLARD DR
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-1958
Mailing Address - Country:US
Mailing Address - Phone:216-791-3800
Mailing Address - Fax:216-229-2338
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-229-2338
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.334616163W00000X
OHAPRN.CNP.17221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.17221OtherCERTIFIED NURSE PRACTITIONER
OH0268768Medicaid