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General NPI Number Information
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NPI Number | 1710341995
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Entity Type | Individual
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Provider Name | CANDACE WIGHT LPN
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Gender | Female
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 257 HOLLY GLENN
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City | MONROE
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State | MI
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Zip | 48161-5761
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Country | US
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Telephone | 734-790-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 257 HOLLY GLENN
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City | MONROE
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State | MI
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Zip | 48161-5761
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Country | US
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Telephone | 734-790-1280
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Fax |
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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 | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703103541
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License Number State | MI
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