Healthcare Provider Details

I. General information

NPI: 1285155945
Provider Name (Legal Business Name): CANDACE K DECOURVILLE APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CANDACE K BISHOP RN

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2839 COPLEY RD
COPLEY OH
44321-2154
US

IV. Provider business mailing address

2839 COPLEY RD
COPLEY OH
44321-2154
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-2022
  • Fax:
Mailing address:
  • Phone: 330-666-2022
  • Fax: 330-665-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021090
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: