Provider Demographics
NPI:1063692069
Name:STEFANCIN, CANDACE (CRNA)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:STEFANCIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:BARAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7630 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5633
Mailing Address - Country:US
Mailing Address - Phone:330-729-8000
Mailing Address - Fax:330-729-8084
Practice Address - Street 1:7630 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5633
Practice Address - Country:US
Practice Address - Phone:330-729-8000
Practice Address - Fax:330-729-8084
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN312099367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2776974Medicaid
OH2776974Medicaid