MEDICARE: MRS. CANDICE CHRISTINA MCKINNON C.N.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care	401722	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225169543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CANDICE CHRISTINA MCKINNON C.N.A

Provider Business Mailing Address
First Line	:	PO BOX 773575
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-3575
Country	:	US
Telephone Number	:	907-696-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	17250 PALOS VERDES DR
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-8133
Country	:	US
Telephone Number	:	907-696-4433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/09/2007

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