Individual
CANDICE LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
316 BEACH 65TH ST, FAR ROCKAWAY, NY 11692-1425
(347) 359-0602
Mailing address
PO BOX 60179, BROOKLYN, NY 11206-0179
(347) 359-0602
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
298848-1
NY
Other
Enumeration date
07/29/2011
Last updated
07/29/2011
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