Individual
CANDICE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2 ADAMS ST, MOUNT VERNON, NY 10550-3504
(347) 866-6643
Mailing address
2 ADAMS ST, MOUNT VERNON, NY 10550-3504
(347) 866-6643
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
3093871
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3093871
NURSING LICENSE
NY
Enumeration date
08/09/2013
Last updated
08/09/2013
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