MEDICARE: CANDACE GARNER MS, RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	219	WY

General Provider Information

NPI Number	:	1497268650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE GARNER MS, RDN

Provider Business Mailing Address
First Line	:	603 RIVERSIDE ST
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 RIVERSIDE ST
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6120
Country	:	US
Telephone Number	:	307-575-4967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	11/09/2017

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