Provider Demographics
NPI:1376067967
Name:WILLETT, CANDACE MARY (PPCNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:MARY
Last Name:WILLETT
Suffix:
Gender:F
Credentials:PPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 M ST NW STE 205
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1449
Mailing Address - Country:US
Mailing Address - Phone:202-955-0003
Mailing Address - Fax:866-457-0397
Practice Address - Street 1:2440 M ST NW STE 205
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-955-0003
Practice Address - Fax:866-457-0397
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10453182080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases