Provider Demographics
NPI:1700568573
Name:LATTIMORE, CANDACE (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:LATTIMORE
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 GREENWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1853
Mailing Address - Country:US
Mailing Address - Phone:716-939-1776
Mailing Address - Fax:
Practice Address - Street 1:3124 MAIN ST. REAR ENTRANCE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1358
Practice Address - Country:US
Practice Address - Phone:716-939-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy