Provider Demographics
NPI:1104550425
Name:BLAUSER, CANDACE LYNNE (NP)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:LYNNE
Last Name:BLAUSER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2930 DOMINGO AVE # 1565
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2454
Mailing Address - Country:US
Mailing Address - Phone:510-399-0793
Mailing Address - Fax:925-309-6404
Practice Address - Street 1:302 SILVER AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1510
Practice Address - Country:US
Practice Address - Phone:415-334-2500
Practice Address - Fax:865-560-7110
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1087438363L00000X, 363LA2200X, 363LG0600X
CA95025230363L00000X
FLAPRN11038996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health