Healthcare Provider Details

I. General information

NPI: 1346732005
Provider Name (Legal Business Name): CANDACE CANTWELL-FOY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE FOY CRNP

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S BROAD ST
PHILADELPHIA PA
19148-3542
US

IV. Provider business mailing address

815 W KING RD
MALVERN PA
19355-2855
US

V. Phone/Fax

Practice location:
  • Phone: 215-873-3742
  • Fax:
Mailing address:
  • Phone: 610-659-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberSP018777
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: