Healthcare Provider Details

I. General information

NPI: 1336763572
Provider Name (Legal Business Name): CANDICE BOCHAT APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CANDICE N CIANCIO APRN, CNP

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 950
CHICAGO IL
60611-2955
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 950
CHICAGO IL
60611-2955
US

V. Phone/Fax

Practice location:
  • Phone: 312-694-7337
  • Fax: 312-926-9116
Mailing address:
  • Phone: 312-694-7337
  • Fax: 312-926-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.021130
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209021130
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: