Provider Demographics
NPI:1548517063
Name:CANDY, MARIE DONALDE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:DONALDE
Last Name:CANDY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 GOVERNORS AVE
Mailing Address - Street 2:HALLMARK HEALTH SYSTEM, INC.
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1643
Mailing Address - Country:US
Mailing Address - Phone:781-306-6000
Mailing Address - Fax:
Practice Address - Street 1:310 PHILIP BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8700
Practice Address - Country:US
Practice Address - Phone:678-971-2020
Practice Address - Fax:770-442-0306
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAF0712497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily