Provider Demographics
NPI:1730590753
Name:KANDEL, CONNIE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:KANDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:2 ARLINGTON CT APT. 1
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-0015
Mailing Address - Country:US
Mailing Address - Phone:330-464-5973
Mailing Address - Fax:
Practice Address - Street 1:2 ARLINGTON COURT APT 1
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:OH
Practice Address - Zip Code:44618
Practice Address - Country:US
Practice Address - Phone:330-464-5973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRL680695172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker