=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750570891
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDACE MICHELLE GHAUL CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 556 EGG HARBOR RD STE B
-----------------------------------------------------
City | SEWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08080-2326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-256-7620
-----------------------------------------------------
Fax | 215-829-5567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 MANSION DR
-----------------------------------------------------
City | MEDIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19063-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-238-1405
-----------------------------------------------------
Fax | 706-650-1034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | RN348651L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 26NJ00506400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------