Healthcare Provider Details

I. General information

NPI: 1699692194
Provider Name (Legal Business Name): CANDACE ALICIA MAWUDOKU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N GRANT ST STE R
DENVER CO
80203-1859
US

IV. Provider business mailing address

1500 N GRANT ST STE R
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 920-400-7107
  • Fax:
Mailing address:
  • Phone: 920-400-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: