Healthcare Provider Details

I. General information

NPI: 1033146121
Provider Name (Legal Business Name): CANDACE CARTER MILLER RN, MS, CWOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

6101 PENELA WAY
EL DORADO HILLS CA
95762-7571
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-7251
  • Fax: 916-843-7120
Mailing address:
  • Phone: 916-939-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number248801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: