Provider Demographics
NPI:1851638423
Name:GINSBERG, CANDACE JACOBS (RN FNP)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:JACOBS
Last Name:GINSBERG
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N 60TH AVE E
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2549
Mailing Address - Country:US
Mailing Address - Phone:218-341-5042
Mailing Address - Fax:
Practice Address - Street 1:130 N 60TH AVE E
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-2549
Practice Address - Country:US
Practice Address - Phone:218-341-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 1032763363LP0200X
MNR1032763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics