Provider Demographics
NPI:1801332440
Name:CANDACE NALLS
Entity type:Organization
Organization Name:CANDACE NALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MISS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-242-8167
Mailing Address - Street 1:4476 CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1365
Mailing Address - Country:US
Mailing Address - Phone:937-242-8167
Mailing Address - Fax:
Practice Address - Street 1:4476 CATALINA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-1365
Practice Address - Country:US
Practice Address - Phone:937-242-8167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN155636251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care