Provider Demographics
NPI:1881353167
Name:WHITE, CANDICE SHANEE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:SHANEE
Last Name:WHITE
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 1:1624 CIMMARON PLZ
Mailing Address - Street 2:STILLWATER, OK 74074
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075
Mailing Address - Country:US
Mailing Address - Phone:405-780-3881
Mailing Address - Fax:
Practice Address - Street 1:1624 CIMMARON PLZ
Practice Address - Street 2:STILLWATER, OK 74074
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075
Practice Address - Country:US
Practice Address - Phone:405-780-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist