Provider Demographics
NPI:1700193216
Name:REID, CANDACE JENE (CNM)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:JENE
Last Name:REID
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10511 GOLF COURSE RD NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5916
Mailing Address - Country:US
Mailing Address - Phone:505-727-4500
Mailing Address - Fax:505-727-4505
Practice Address - Street 1:10511 GOLF COURSE RD NW
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5916
Practice Address - Country:US
Practice Address - Phone:505-727-4500
Practice Address - Fax:505-727-4030
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM606367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77604342Medicaid