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General NPI Number Information
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NPI Number | 1417352287
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Entity Type | Individual
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Provider Name | CANDIS M TOOTHMAN APRN
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Gender | Female
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 597 LIBERT STREET SUITE 15
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City | WEST MILFORD
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State | WV
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Zip | 26451
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Country | US
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Telephone | 304-745-4568
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Fax | 304-326-3700
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Provider Business Mailing Address
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Address Line | 597 LIBERTY STREET
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City | WEST MILFORD
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State | WV
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Zip | 26451
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Country | US
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Telephone | 304-745-4568
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Fax | 304-326-3700
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 73558
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License Number State | WV
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