Provider Demographics
NPI:1790175370
Name:CANDACE MALSON NP PLC
Entity Type:Organization
Organization Name:CANDACE MALSON NP PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-661-1755
Mailing Address - Street 1:9755 N 90TH ST
Mailing Address - Street 2:SUITE C200
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5046
Mailing Address - Country:US
Mailing Address - Phone:480-661-1755
Mailing Address - Fax:480-661-9636
Practice Address - Street 1:9755 N 90TH ST
Practice Address - Street 2:SUITE C200
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5046
Practice Address - Country:US
Practice Address - Phone:480-661-1755
Practice Address - Fax:480-661-9636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ168749Medicare PIN