Provider Demographics
NPI:1497636260
Name:NICANDRO, ANTHONY JAMES SR (MSN, BSN, RN, CEO)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JAMES
Last Name:NICANDRO
Suffix:SR
Gender:M
Credentials:MSN, BSN, RN, CEO
Other - Prefix:MRS
Other - First Name:MADONA
Other - Middle Name:
Other - Last Name:DEDIOS-NICANDRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN, DIRECTOR
Mailing Address - Street 1:2251 MUSCAT PL
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-8236
Mailing Address - Country:US
Mailing Address - Phone:559-309-8489
Mailing Address - Fax:559-772-4532
Practice Address - Street 1:2251 MUSCAT PL
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-8236
Practice Address - Country:US
Practice Address - Phone:559-309-8489
Practice Address - Fax:559-772-4532
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA807435163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy