Provider Demographics
NPI:1104170117
Name:BAUER-RICK, CANDYCE LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:CANDYCE
Middle Name:LYNN
Last Name:BAUER-RICK
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 1:128 N CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1352
Mailing Address - Country:US
Mailing Address - Phone:330-722-1069
Mailing Address - Fax:330-764-9712
Practice Address - Street 1:801 E WASHINGTON ST
Practice Address - Street 2:SUITE 150
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3335
Practice Address - Country:US
Practice Address - Phone:330-722-1069
Practice Address - Fax:330-764-9712
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.134079-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse