Provider Demographics
NPI:1417284928
Name:VERDOORN, CANDACE L (CNP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:L
Last Name:VERDOORN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:SD
Mailing Address - Zip Code:57014-0070
Mailing Address - Country:US
Mailing Address - Phone:605-563-2411
Mailing Address - Fax:605-563-2060
Practice Address - Street 1:512 BROADWAY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:SD
Practice Address - Zip Code:57014-0070
Practice Address - Country:US
Practice Address - Phone:605-563-2411
Practice Address - Fax:605-563-2060
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDRO28156OtherLICENSE-RN
SDCP000583OtherNURSE PRACTITIONER LICENSE