Healthcare Provider Details

I. General information

NPI: 1649998923
Provider Name (Legal Business Name): CANDICE SCHRUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2844 AZALEA PL SW
LOVELAND CO
80537-6015
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1640664
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: