Most Relevant Information
Provider Data
| NPI Number: | 1003442880 |
| Provider Name: | CANDICE VICENCIO DNP, FNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 209020086 |
Most Important Dates
| Enumeration Date: | 03/12/2020 |
| Last Updated: | 05/06/2024 |
Provider Practice Location
4215 NEWBURG RD
ROCKFORD
IL
611086479
Practice Location Phone/Fax
| Phone: | 8159888500 |
| Fax: | 8159775956 |
Provider Mailing Location
4215 NEWBURG RD
ROCKFORD
IL
611086479
Provider Mailing Phone/Fax
| Phone: | 8159888500 |
| Fax: | 8159775956 |