MEDICARE: CANDACE JOYCE HAWORTH 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	86150993	NV

General Provider Information

NPI Number	:	1528683547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE JOYCE HAWORTH RDN

Provider Business Mailing Address
First Line	:	5950 ROSE SAGE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-5050
Country	:	US
Telephone Number	:	702-738-0543
Fax Number	:

Provider Business Practice Location Address
First Line	:	5950 ROSE SAGE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-5050
Country	:	US
Telephone Number	:	702-738-0543
Fax Number	:

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

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	06/15/2020

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