Provider Demographics
NPI:1801629118
Name:NTIAMOAH, CANDACE (NP)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:NTIAMOAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3597 KINGSWAY DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8934
Mailing Address - Country:US
Mailing Address - Phone:773-619-1192
Mailing Address - Fax:
Practice Address - Street 1:3597 KINGSWAY DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8934
Practice Address - Country:US
Practice Address - Phone:773-619-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28194594A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse