Healthcare Provider Details

I. General information

NPI: 1417352287
Provider Name (Legal Business Name): CANDIS M TOOTHMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 LIBERT STREET SUITE 15
WEST MILFORD WV
26451
US

IV. Provider business mailing address

597 LIBERTY STREET
WEST MILFORD WV
26451
US

V. Phone/Fax

Practice location:
  • Phone: 304-745-4568
  • Fax: 304-326-3700
Mailing address:
  • Phone: 304-745-4568
  • Fax: 304-326-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number73558
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: