Provider Demographics
NPI:1902686124
Name:BOLANDER, CANDICE DAWN (APRN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:DAWN
Last Name:BOLANDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 MANHATTAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2987
Mailing Address - Country:US
Mailing Address - Phone:504-349-6930
Mailing Address - Fax:
Practice Address - Street 1:2845 MANHATTAN BLVD
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2987
Practice Address - Country:US
Practice Address - Phone:504-349-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231112363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care