Healthcare Provider Details

I. General information

NPI: 1396463089
Provider Name (Legal Business Name): CANDACE PHILLIPS LARAMORE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N SILVER ST
SILVER CITY NM
88061-7201
US

IV. Provider business mailing address

1618 E PINE ST
SILVER CITY NM
88061-7155
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1889
  • Fax: 575-388-9952
Mailing address:
  • Phone: 575-388-1561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69441
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: