Healthcare Provider Details

I. General information

NPI: 1548697923
Provider Name (Legal Business Name): CANDACE JOYCE COLON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CANDACE JOYCE COLIN

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 01/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 SPRUCE AVE
ROCHESTER NY
14611-4040
US

IV. Provider business mailing address

PO BOX 90331
ROCHESTER NY
14609-0331
US

V. Phone/Fax

Practice location:
  • Phone: 585-363-1717
  • Fax:
Mailing address:
  • Phone: 585-363-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number315666
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number315666
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: