Provider Demographics
NPI:1750104840
Name:CUNNINGHAM, CANDACE JO (LPN)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:JO
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 451692
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74345-1692
Mailing Address - Country:US
Mailing Address - Phone:918-860-0514
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 451692
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74345-1692
Practice Address - Country:US
Practice Address - Phone:918-860-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0053390164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse