Provider Demographics
NPI:1972938272
Name:LOPEZ, KANDICE CRYSTAL (CNA)
Entity type:Individual
Prefix:MRS
First Name:KANDICE
Middle Name:CRYSTAL
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:KANDICE
Other - Middle Name:CRYSTAL
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:11310 MELODY DR
Mailing Address - Street 2:APT. 4-205
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3053
Mailing Address - Country:US
Mailing Address - Phone:720-325-6012
Mailing Address - Fax:
Practice Address - Street 1:11310 MELODY DR
Practice Address - Street 2:APT. 4-205
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3053
Practice Address - Country:US
Practice Address - Phone:720-325-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00751319376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00751319OtherSTATE OF COLORADO