Provider Demographics
NPI:1932536331
Name:ROYAL, CANDIUS M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CANDIUS
Middle Name:M
Last Name:ROYAL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CANDIUS
Other - Middle Name:M
Other - Last Name:ROYAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2250 PAR LN APT 200
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-2925
Mailing Address - Country:US
Mailing Address - Phone:216-712-0548
Mailing Address - Fax:
Practice Address - Street 1:2250 PAR LN
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-2921
Practice Address - Country:US
Practice Address - Phone:216-712-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN153445MIV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse