=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609496512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REDBUD FAMILY HEALTH, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2020
-----------------------------------------------------
Last Update Date | 04/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1823 N LOCUST ST
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76201-3069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-218-8506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2409 PRESCOTT DOWNS DR
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-3690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-218-8506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PROVIDER
-----------------------------------------------------
Name | DR. ELAINE VERONICA CANDELORO
-----------------------------------------------------
Credential | DNP, APRN, CNM, FNP
-----------------------------------------------------
Telephone | 940-218-8506
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------