Healthcare Provider Details

I. General information

NPI: 1780752592
Provider Name (Legal Business Name): CANDI D. ERVEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 10/10/2020
Certification Date: 10/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 W REPUBLIC RD
SPRINGFIELD MO
65807-4682
US

IV. Provider business mailing address

3045 W REPUBLIC RD
SPRINGFIELD MO
65807-4682
US

V. Phone/Fax

Practice location:
  • Phone: 417-889-0056
  • Fax:
Mailing address:
  • Phone: 417-889-0056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number142247
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: