Provider Demographics
NPI:1740011287
Name:SMITH, CANDACE DENISE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:DENISE
Last Name:SMITH
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 1:2222 LARIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-1424
Mailing Address - Country:US
Mailing Address - Phone:531-247-0995
Mailing Address - Fax:
Practice Address - Street 1:2222 LARIMORE AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-1424
Practice Address - Country:US
Practice Address - Phone:531-247-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2025-08-07
Deactivation Date:2024-08-12
Deactivation Code:
Reactivation Date:2025-08-07
Provider Licenses
StateLicense IDTaxonomies
NE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health