Provider Demographics
NPI:1063685642
Name:DUNCAN, CANDI LE (MP)
Entity Type:Individual
Prefix:MRS
First Name:CANDI
Middle Name:LE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 21ST AVE SW
Mailing Address - Street 2:A203
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7507
Mailing Address - Country:US
Mailing Address - Phone:253-678-6738
Mailing Address - Fax:
Practice Address - Street 1:209 21ST AVE SW
Practice Address - Street 2:A203
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7507
Practice Address - Country:US
Practice Address - Phone:253-678-6738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist