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General NPI Number Information
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NPI Number | 1316449820
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Entity Type | Individual
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Provider Name | CANDUS NICOLE ANTOLIN MD
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Gender | Female
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 9923A E. JOHNSON ST MADIGAN ANNEX, JBLM
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City | TACOMA
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State | WA
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Zip | 98498
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Country | US
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Telephone | 253-968-6485
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Fax |
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Provider Business Mailing Address
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Address Line | 9923A E. JOHNSON ST MADIGAN ANNEX, JBLM
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City | TACOMA
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State | WA
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Zip | 98498
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD-21233
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License Number State | HI
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