Provider Demographics
NPI:1700836905
Name:LEAPHART-ST CLOUD, CANDANCE (DO)
Entity Type:Individual
Prefix:
First Name:CANDANCE
Middle Name:
Last Name:LEAPHART-ST CLOUD
Suffix:
Gender:F
Credentials:DO
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 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-579-3272
Mailing Address - Fax:702-667-4667
Practice Address - Street 1:1505 WIGWAM PKWY STE 241
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8195
Practice Address - Country:US
Practice Address - Phone:702-852-3112
Practice Address - Fax:702-933-8705
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113883207V00000X
NVDO1945207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700836905Medicaid
IL036113883OtherSTATE LICENSE
NV1700836905Medicaid
IL036113883Medicaid
WI1700836905Medicaid
NV1700836905Medicaid