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Individual

CANDICE CAMILLE GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CLPN

Contact information

Practice address
5100 POPLAR AVE FL 27, MEMPHIS, TN 38137-2701
(662) 815-0547
(901) 878-3181
Mailing address
5100 POPLAR AVE FL 27, MEMPHIS, TN 38137-2701
(662) 815-0547
(901) 878-3181

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
170003387
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
170003387
BUSINESS LICENSE
TN
Enumeration date
06/05/2019
Last updated
06/05/2019
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