Provider Demographics
NPI:1891233714
Name:EISENHART, CANDEE J (NP)
Entity Type:Individual
Prefix:
First Name:CANDEE
Middle Name:J
Last Name:EISENHART
Suffix:
Gender:F
Credentials:NP
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 1009
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1821
Mailing Address - Country:US
Mailing Address - Phone:480-815-7074
Mailing Address - Fax:949-404-6076
Practice Address - Street 1:21321 E OCOTILLO RD STE 102
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:480-815-7074
Practice Address - Fax:949-404-6076
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-11
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ131305390200000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program