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NPI Code Detail

MEDICARE: CANDACE BERLYNN PATEL FNP-BC

MEDICARE: CANDACE BERLYNN PATEL FNP-BC
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
1163W00000XRegistered NurseRN172192AZ
2363LW0102XWomen's Health Nurse Practitioner56144NM
3363LP2300XPrimary Care Nurse Practitioner244439AZ

General Provider Information

NPI Number : 1700151362
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE BERLYNN PATEL FNP-BC
Provider Business Mailing Address
First Line : 2001 N 4TH ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-4227
Country : US
Telephone Number : 928-527-4325
Fax Number :
Provider Business Practice Location Address
First Line : 2001 N 4TH ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-4227
Country : US
Telephone Number : 928-527-4325
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2012
Last Update Date : 08/13/2020

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Directions to “ CANDACE BERLYNN PATEL FNP-BC” Practice Location

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