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:
Health care specialties
| Specialty | Code | License # | 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 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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