Provider Demographics
NPI:1225850795
Name:WHITE, CANDACE NICOLE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:NICOLE
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 1:10509 BELLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5009
Mailing Address - Country:US
Mailing Address - Phone:405-227-3684
Mailing Address - Fax:
Practice Address - Street 1:10509 BELLVIEW DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5009
Practice Address - Country:US
Practice Address - Phone:405-227-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist