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NPI Code Detail

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

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
1163W00000XRegistered Nurse653544CA
2363LF0000XFamily Nurse Practitioner23718CA
3363L00000XNurse Practitioner23718CA

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 : 101 THE CITY DR S
Second Line :
City : ORANGE
State : CA
Zip : 92868-3201
Country : US
Telephone Number : 714-456-8888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 06/02/2026

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