Provider Demographics
NPI:1548309024
Name:ZICKLER, CANDACE F (CPNP)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:F
Last Name:ZICKLER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3372 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1120
Mailing Address - Country:US
Mailing Address - Phone:937-299-5014
Mailing Address - Fax:937-299-5014
Practice Address - Street 1:1 CHILDRENS PLZ
Practice Address - Street 2:DEVELOPMENTAL PEDIATRICS
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1898
Practice Address - Country:US
Practice Address - Phone:937-641-4000
Practice Address - Fax:937-641-5076
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-264091363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics