Provider Demographics
NPI:1699160085
Name:THAYER, CANDALYNE
Entity type:Individual
Prefix:
First Name:CANDALYNE
Middle Name:
Last Name:THAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 S OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48819-9741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1175 S OSBORNE RD
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48819-9741
Practice Address - Country:US
Practice Address - Phone:517-909-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703085837164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse