Healthcare Provider Details

I. General information

NPI: 1770740334
Provider Name (Legal Business Name): CANDIA KATHLEEN LUBY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 SNOW ROAD
PARMA OH
44133
US

IV. Provider business mailing address

12301 SNOW ROAD
PARMA OH
44133
US

V. Phone/Fax

Practice location:
  • Phone: 216-265-4432
  • Fax: 216-265-4478
Mailing address:
  • Phone: 216-265-4432
  • Fax: 216-265-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number149131
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number09976
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: