Provider Demographics
NPI:1548028798
Name:PERRY, CANDACE (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MOTIF BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1065
Mailing Address - Country:US
Mailing Address - Phone:317-735-6677
Mailing Address - Fax:
Practice Address - Street 1:23 MOTIF BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1065
Practice Address - Country:US
Practice Address - Phone:317-735-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INN23107361246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy