Healthcare Provider Details

I. General information

NPI: 1750570891
Provider Name (Legal Business Name): CANDACE MICHELLE GHAUL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 07/08/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 EGG HARBOR RD STE B
SEWELL NJ
08080-2326
US

IV. Provider business mailing address

104 MANSION DR
MEDIA PA
19063-1020
US

V. Phone/Fax

Practice location:
  • Phone: 856-256-7620
  • Fax: 215-829-5567
Mailing address:
  • Phone: 609-238-1405
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN348651L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00506400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: