Healthcare Provider Details

I. General information

NPI: 1477120392
Provider Name (Legal Business Name): CANDICE DEANNA AUBRY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 WEST LINCOLN HIGHWAY
EXTON PA
19341-2514
US

IV. Provider business mailing address

690 WEST LINCOLN HIGHWAY
EXTON PA
19341-2514
US

V. Phone/Fax

Practice location:
  • Phone: 610-873-5437
  • Fax: 484-713-5073
Mailing address:
  • Phone: 610-873-5437
  • Fax: 484-713-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberSP023842
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP023842
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: