Healthcare Provider Details

I. General information

NPI: 1417284928
Provider Name (Legal Business Name): CANDACE L VERDOORN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 BROADWAY
CENTERVILLE SD
57014-0070
US

IV. Provider business mailing address

PO BOX 70
CENTERVILLE SD
57014-0070
US

V. Phone/Fax

Practice location:
  • Phone: 605-563-2411
  • Fax: 605-563-2060
Mailing address:
  • Phone: 605-563-2411
  • Fax: 605-563-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000583
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: