Provider Demographics
NPI:1861024796
Name:CANDALERA, EVELYN VILLARDE (NP-C)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:VILLARDE
Last Name:CANDALERA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3644
Mailing Address - Country:US
Mailing Address - Phone:973-744-7337
Mailing Address - Fax:973-744-5049
Practice Address - Street 1:33 N FULLERTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3644
Practice Address - Country:US
Practice Address - Phone:973-744-7337
Practice Address - Fax:973-744-5049
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAG02200018363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner