Provider Demographics
NPI:1659500395
Name:ALLEN, CANDY (CASE MANAGER)
Entity Type:Individual
Prefix:MS
First Name:CANDY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 74 BOX 22208
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-9522
Mailing Address - Country:US
Mailing Address - Phone:575-751-1307
Mailing Address - Fax:
Practice Address - Street 1:413 SIPAPU ROAD
Practice Address - Street 2:
Practice Address - City:TAPS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-751-7552
Practice Address - Fax:575-751-7718
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator