Healthcare Provider Details

I. General information

NPI: 1790476331
Provider Name (Legal Business Name): CANDACE CONAWAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 02/21/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19411 PLANTATION RD UNIT 3
REHOBOTH BEACH DE
19971-4497
US

IV. Provider business mailing address

19411 PLANTATION RD UNIT 3
REHOBOTH BEACH DE
19971-4497
US

V. Phone/Fax

Practice location:
  • Phone: 302-291-2374
  • Fax: 302-291-2403
Mailing address:
  • Phone: 302-291-2374
  • Fax: 302-291-2403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0012333
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: