Healthcare Provider Details

I. General information

NPI: 1306834999
Provider Name (Legal Business Name): CANDYACE A DUNN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16490 W 78TH ST
EDEN PRAIRIE MN
55346-4300
US

IV. Provider business mailing address

APPOMATTOX FAMILY PRACTICE P O BOX 607
APPOMATTOX VA
24522-0607
US

V. Phone/Fax

Practice location:
  • Phone: 304-225-2500
  • Fax: 304-985-6350
Mailing address:
  • Phone: 434-352-8235
  • Fax: 434-352-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024165822
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: