Provider Demographics
NPI:1285030619
Name:CANDELA, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:CANDELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LEANN
Other - Last Name:CANDELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:400 PALO VERDE DR
Mailing Address - Street 2:(PORTABLE C-128)
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6028
Mailing Address - Country:US
Mailing Address - Phone:702-799-0508
Mailing Address - Fax:702-799-0510
Practice Address - Street 1:400 PALO VERDE DR.
Practice Address - Street 2:(PORTABLE C-128)
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89101-7638
Practice Address - Country:US
Practice Address - Phone:702-799-0508
Practice Address - Fax:702-799-0510
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV000873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily