Provider Demographics
NPI:1396091492
Name:PATE, CANDICE H (CD, AAHCC)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:H
Last Name:PATE
Suffix:
Gender:F
Credentials:CD, AAHCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15390 HUGH RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-3857
Mailing Address - Country:US
Mailing Address - Phone:205-246-2165
Mailing Address - Fax:
Practice Address - Street 1:15390 HUGH RUSSELL DR
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-3857
Practice Address - Country:US
Practice Address - Phone:205-246-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6418632374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula