Basic Information
| Provider Information | |||||||||
| NPI: | 1841385101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLARE | ||||||||
| FirstName: | CANDIS | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | COMDT CG-1122 COAST GUARD 2100 2ND ST SW | ||||||||
| Address2: | SUITE 5314 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 205930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863075017 | ||||||||
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| Practice Location | |||||||||
| Address1: | COMDT CG-1122 COAST GUARD 2100 2ND ST SW | ||||||||
| Address2: | SUITE 5314 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 205930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863075017 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.