Provider Demographics
NPI:1497268650
Name:GARNER, CANDACE (MS, RDN)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:WOLLERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:603 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 RIVERSIDE ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6120
Practice Address - Country:US
Practice Address - Phone:307-575-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY219133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered