Provider Demographics
NPI:1427423011
Name:DEBEAU, KANDICE JOY (RN)
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:JOY
Last Name:DEBEAU
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:PO BOX 603
Mailing Address - Street 2:4225 GOOSENECK RD
Mailing Address - City:DELEVAN
Mailing Address - State:NY
Mailing Address - Zip Code:14042-0603
Mailing Address - Country:US
Mailing Address - Phone:716-244-8853
Mailing Address - Fax:
Practice Address - Street 1:4225 GOOSENECK RD
Practice Address - Street 2:
Practice Address - City:DELEVAN
Practice Address - State:NY
Practice Address - Zip Code:14042-9715
Practice Address - Country:US
Practice Address - Phone:716-244-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY709829-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse