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NPI Code Detail

MEDICARE: CANDACE NTIAMOAH FNP

MEDICARE: CANDACE NTIAMOAH FNP
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 Nurse28194594AIN
2363LF0000XFamily Nurse Practitioner71016628AIN

General Provider Information

NPI Number : 1801629118
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE NTIAMOAH FNP
Provider Business Mailing Address
First Line : PO BOX 1431
Second Line : DEPT 400
City : CHARLOTTE
State : NC
Zip : 28201-1431
Country : US
Telephone Number : 877-504-2049
Fax Number :
Provider Business Practice Location Address
First Line : 3512 STELLHORN RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-4631
Country : US
Telephone Number : 877-504-2049
Fax Number : 260-483-9196
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2024
Last Update Date : 06/26/2026

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