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General NPI Number Information
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NPI Number | 1548309024
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Entity Type | Individual
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Provider Name | CANDACE F. ZICKLER CPNP
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 CHILDRENS PLZ DEVELOPMENTAL PEDIATRICS
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City | DAYTON
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State | OH
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Zip | 45404-1898
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Country | US
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Telephone | 937-641-4000
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Fax | 937-641-5076
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Provider Business Mailing Address
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Address Line | 3372 RIDGEWAY RD
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City | KETTERING
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State | OH
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Zip | 45419-1120
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Country | US
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Telephone | 937-299-5014
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Fax | 937-299-5014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN-264091
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License Number State | OH
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