Individual
CANDY LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11 MENTELLE PARK, LEXINGTON, KY 40502-1511
(859) 396-5358
Mailing address
11 MENTELLE PARK, LEXINGTON, KY 40502-1511
(859) 396-5358
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1147654
KY
Other
Enumeration date
09/09/2016
Last updated
03/07/2017
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