Provider Demographics
NPI:1508060930
Name:OEN, CANDACE (P A -C)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:OEN
Suffix:
Gender:F
Credentials:P A -C
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 1046
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-1046
Mailing Address - Country:US
Mailing Address - Phone:928-632-8278
Mailing Address - Fax:928-632-0105
Practice Address - Street 1:13175 E HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-7372
Practice Address - Country:US
Practice Address - Phone:928-632-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2077363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant