Provider Demographics
NPI:1013451061
Name:CANDELORO, ELAINE VERONICA (CNM)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:VERONICA
Last Name:CANDELORO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3069
Mailing Address - Country:US
Mailing Address - Phone:940-483-1569
Mailing Address - Fax:
Practice Address - Street 1:1823 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3069
Practice Address - Country:US
Practice Address - Phone:940-483-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX893247367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife