Provider Demographics
NPI:1336763572
Name:BOCHAT, CANDICE (APRN, CNP)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:BOCHAT
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:N
Other - Last Name:CIANCIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, CNP
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 950
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2955
Mailing Address - Country:US
Mailing Address - Phone:312-694-7337
Mailing Address - Fax:312-926-9116
Practice Address - Street 1:676 N SAINT CLAIR ST STE 950
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2955
Practice Address - Country:US
Practice Address - Phone:312-694-7337
Practice Address - Fax:312-926-9116
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021130363LF0000X
IL209021130363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.021130OtherIDPH