Provider Demographics
NPI:1750135026
Name:CANDOLESAS, MIKAELA ANGELA BADORIA (APRN-NP)
Entity type:Individual
Prefix:
First Name:MIKAELA ANGELA
Middle Name:BADORIA
Last Name:CANDOLESAS
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S RANCHO DR STE E6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3812
Mailing Address - Country:US
Mailing Address - Phone:702-240-6482
Mailing Address - Fax:
Practice Address - Street 1:38 S WATER ST STE 310
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7493
Practice Address - Country:US
Practice Address - Phone:702-240-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV879696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily