Healthcare Provider Details

I. General information

NPI: 1609247832
Provider Name (Legal Business Name): CANDACE MIX MSN, RN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 5TH AVE CONSULTATION & LIAISON SERVICE, LOWER LEVEL
PITTSBURGH PA
15213-3320
US

IV. Provider business mailing address

207 SUMMIT DR
BLAWNOX PA
15238-2921
US

V. Phone/Fax

Practice location:
  • Phone: 412-383-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN625613
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: