Provider Demographics
NPI:1386254290
Name:WELLWOOD, CANDIE M (ARNP)
Entity type:Individual
Prefix:
First Name:CANDIE
Middle Name:M
Last Name:WELLWOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CANDIE
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:731 N STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022
Mailing Address - Country:US
Mailing Address - Phone:509-299-6900
Mailing Address - Fax:509-351-2818
Practice Address - Street 1:731 N STANLEY ST
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8940
Practice Address - Country:US
Practice Address - Phone:509-299-6900
Practice Address - Fax:509-351-2818
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61025826363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health