Provider Demographics
NPI:1306067665
Name:DEFUSCO, CANDACE (RN)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:DEFUSCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 JOHN POTTER ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817
Mailing Address - Country:US
Mailing Address - Phone:401-397-8473
Mailing Address - Fax:401-726-5571
Practice Address - Street 1:94 JOHN POTTER ROAD
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817
Practice Address - Country:US
Practice Address - Phone:401-397-8473
Practice Address - Fax:401-726-5571
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN37646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30343OtherBLUE CROSS CRISIS