Provider Demographics
NPI:1265841159
Name:MABBITT, CANDACE (CNM, WHNP-BC, PMHNP)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:MABBITT
Suffix:
Gender:F
Credentials:CNM, WHNP-BC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15260 NE 15TH PL APT B
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4592
Mailing Address - Country:US
Mailing Address - Phone:623-256-7609
Mailing Address - Fax:
Practice Address - Street 1:6553 CALIFORNIA AVE SW STE B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1896
Practice Address - Country:US
Practice Address - Phone:206-659-7299
Practice Address - Fax:206-659-7299
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61574928363LP0808X
WAAP 60576932367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health