1649903352 NPI number — CANDACE MACHELLE LAMONACA REGISTERED NURSE

Table of content: CANDACE MACHELLE LAMONACA REGISTERED NURSE (NPI 1649903352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649903352 NPI number — CANDACE MACHELLE LAMONACA REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMONACA
Provider First Name:
CANDACE
Provider Middle Name:
MACHELLE
Provider Name Prefix Text:
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:
GILMORE
Provider Other First Name:
CANDACE
Provider Other Middle Name:
MACHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTRED NURSE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649903352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6005 N COATIMUNDI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85750-0812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-431-7922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6005 N COATIMUNDI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85750-0812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-431-7922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2022

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: 163WC1500X , with the licence number:  RN189909 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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