Healthcare Provider Details

I. General information

NPI: 1588013619
Provider Name (Legal Business Name): CANDACE MARIE MORALES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 NORTHRISE DR STE 1
LAS CRUCES NM
88011-6839
US

IV. Provider business mailing address

3030 PICACHO STREET SUITE D
LAS CRUCES NM
88007
US

V. Phone/Fax

Practice location:
  • Phone: 575-382-2161
  • Fax: 575-382-2172
Mailing address:
  • Phone: 575-532-4427
  • Fax: 575-532-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR52219
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02995
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: