Candice Lynne Vitale, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704277903 Issued in MI

Practice address

43475 Dalcoma Drive
Ste 150
Clinton TWP, MI 48038

Phone

(877) 784-3667

Fax

(248) 869-3982

NPI assigned

Jun 17, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Candice Nichols Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525305600000",
    "number": "1386083046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29275 NORTHWESTERN HWY",
            "address_2": "STE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48034",
            "telephone_number": "877-784-3667",
            "fax_number": "248-869-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43475 DALCOMA DRIVE",
            "address_2": "STE 150",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "48038",
            "telephone_number": "877-784-3667",
            "fax_number": "248-869-3982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITALE",
        "first_name": "CANDICE",
        "middle_name": "LYNNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-17",
        "last_updated": "2018-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704277903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDICE",
            "last_name": "NICHOLS",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Grace Marie Vanhamme, OTA
• Anne Marie Vanraaphorst, OTR
• Deborah Lois Varner, SOCIAL WORKER
• Sunitha Varughese, PA-C
• Courtney Nicole Velasquez
• Rebecca Viviano
• Alyssa Voiland, COTA/L
• Thomas Vokal, D.D.S.
• Sanjay A Vora, D.O.
• Nirzari Vyas, P.T.

• Nurse Practitioner in Clinton TWP, MI
• Providers in Clinton TWP, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.