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General NPI Number Information
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NPI Number | 1508060930
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Entity Type | Individual
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Provider Name | CANDACE OEN P. A. -C.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13175 E HIGHWAY 169
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City | DEWEY
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State | AZ
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Zip | 86327-7372
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Country | US
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Telephone | 928-632-0111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1046
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City | DEWEY
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State | AZ
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Zip | 86327-1046
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Country | US
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Telephone | 928-632-8278
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Fax | 928-632-0105
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2077
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License Number State | AZ
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