Provider Demographics
NPI:1548697923
Name:COLON, CANDACE JOYCE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CANDACE
Middle Name:JOYCE
Last Name:COLON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:JOYCE
Other - Last Name:COLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 90331
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-0331
Mailing Address - Country:US
Mailing Address - Phone:585-363-1717
Mailing Address - Fax:
Practice Address - Street 1:199 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-4040
Practice Address - Country:US
Practice Address - Phone:585-363-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315666164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse