Provider Demographics
NPI:1134833569
Name:HAMRE, CANDICE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:HAMRE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 S CHOCTAW RD
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-6028
Mailing Address - Country:US
Mailing Address - Phone:480-490-2270
Mailing Address - Fax:
Practice Address - Street 1:21001 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-6591
Practice Address - Country:US
Practice Address - Phone:405-391-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily