Provider Demographics
NPI:1124770946
Name:CANDE, CORRY DESART (MED, CCLS, NBC-HWC)
Entity type:Individual
Prefix:
First Name:CORRY
Middle Name:DESART
Last Name:CANDE
Suffix:
Gender:F
Credentials:MED, CCLS, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3610
Mailing Address - Country:US
Mailing Address - Phone:682-433-6979
Mailing Address - Fax:
Practice Address - Street 1:753 SOUTHERN HILLS DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3610
Practice Address - Country:US
Practice Address - Phone:682-433-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3520389