1265239065 NPI number — MRS. CANDACE LEANN MADDEN REGISTERED NURSE

Table of content: MRS. CANDACE LEANN MADDEN REGISTERED NURSE (NPI 1265239065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265239065 NPI number — MRS. CANDACE LEANN MADDEN REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADDEN
Provider First Name:
CANDACE
Provider Middle Name:
LEANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FACIO
Provider Other First Name:
CANDACE
Provider Other Middle Name:
LEANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED NURSE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265239065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1522
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOGANDALE
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89021-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-413-2885
Provider Business Mailing Address Fax Number:
702-789-5519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4730 LEAVITT ST # 1522
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGANDALE
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89021-9987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-413-2885
Provider Business Practice Location Address Fax Number:
702-789-5519
Provider Enumeration Date:
02/27/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN33486 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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