Healthcare Provider Details

I. General information

NPI: 1245106012
Provider Name (Legal Business Name): CANDY LYN VARAKSIN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N STATE ROUTE 89
PRESCOTT AZ
86313-5001
US

IV. Provider business mailing address

500 N STATE ROUTE 89
PRESCOTT AZ
86313-5001
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-4860
  • Fax:
Mailing address:
  • Phone: 928-445-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberTH3333
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number0738
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: