Provider Demographics
NPI:1316460512
Name:ANTHONY, CANDICE (LPN)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:ANTHONY
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 1:14429 183RD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3354
Mailing Address - Country:US
Mailing Address - Phone:347-534-8378
Mailing Address - Fax:
Practice Address - Street 1:144-29 183RD STREET
Practice Address - Street 2:2ND UNIT
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1141
Practice Address - Country:US
Practice Address - Phone:347-534-8378
Practice Address - Fax:347-534-8378
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290722164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse