Healthcare Provider Details

I. General information

NPI: 1104550425
Provider Name (Legal Business Name): CANDACE LYNNE BLAUSER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 DOMINGO AVE # 1565
BERKELEY CA
94705-2454
US

IV. Provider business mailing address

2930 DOMINGO AVE # 1565
BERKELEY CA
94705-2454
US

V. Phone/Fax

Practice location:
  • Phone: 510-399-0793
  • Fax:
Mailing address:
  • Phone: 510-399-0793
  • Fax: 925-309-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1087438
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95025230
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11038996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: