Provider Demographics
NPI:1629102330
Name:CARSON, CANDACE L (RNFA)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:L
Last Name:CARSON
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:L
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:21401 72ND AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7702
Mailing Address - Country:US
Mailing Address - Phone:425-774-2636
Mailing Address - Fax:425-774-2688
Practice Address - Street 1:21401 72ND AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7702
Practice Address - Country:US
Practice Address - Phone:425-774-2636
Practice Address - Fax:452-774-2688
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00069018163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical