Van Iderstine, Candice Lea

Van Iderstine, Candice Lea is an individual health care provider with primary practice located at 15003 Health Center Dr , Bowie MD 20716-1017. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Van Iderstine, Candice Lea can be contacted via phone (301) 809-2090.

Contact Information

Primary practice address
15003 Health Center Dr Bowie MD 20716-1017
Phone: (301) 809-2090
Fax: (301) 809-2034
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 14653 Maryland

Profile Details

NPI number 1174627798
LBN Legal business name Van Iderstine, Candice Lea
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 12th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174627798 NPPES
Maryland Other 7082461 AETNA HMO PROVIDER NUMBER
Maryland Other KFK1 AETNA HMO PROVIDER NUMBER
Maryland Other 2142926 AETNA HMO PROVIDER NUMBER
Maryland Other 3346568 AETNA HMO PROVIDER NUMBER
Maryland Other 0001 AETNA HMO PROVIDER NUMBER

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