Healthcare Provider Details

I. General information

NPI: 1194643460
Provider Name (Legal Business Name): CANDICE BALFOUR
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: CANDICE WILLIAMS

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GRANT ST
BRIDGEPORT CT
06610-2805
US

IV. Provider business mailing address

151 FOREST RD
WEST HAVEN CT
06516-1606
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17622
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: