Provider Demographics
NPI:1174911184
Name:WIRGES, CANDY (LPN)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:
Last Name:WIRGES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 65TH AVENUE CT SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2504
Mailing Address - Country:US
Mailing Address - Phone:253-343-3751
Mailing Address - Fax:
Practice Address - Street 1:1201 S PROCTOR ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2047
Practice Address - Country:US
Practice Address - Phone:253-241-4237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-27
Last Update Date:2014-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60319194164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse