MEDICARE: DR. CANDICE ELIZABETH WHEALON R.N., FNP-C

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	363L00000X	Nurse Practitioner	23718	CA
2	363LF0000X	Family Nurse Practitioner	23718	CA
3	163W00000X	Registered Nurse	653544	CA

General Provider Information

NPI Number	:	1790830404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDICE ELIZABETH WHEALON R.N., FNP-C

Provider Business Mailing Address
First Line	:	11620 WILSHIRE BLVD STE 600
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1776
Country	:	US
Telephone Number	:	805-479-8503
Fax Number	:	310-362-9240

Provider Business Practice Location Address
First Line	:	11620 WILSHIRE BLVD STE 600
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1776
Country	:	US
Telephone Number	:	805-479-8503
Fax Number	:	310-362-9240

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	10/27/2025

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