Provider Demographics
NPI:1396535605
Name:MILLER, CANDICE RENAE (BSN)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:RENAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:RENAE
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9888 N ELKHORN RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4591
Mailing Address - Country:US
Mailing Address - Phone:801-673-0950
Mailing Address - Fax:
Practice Address - Street 1:3848 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-0001
Practice Address - Country:US
Practice Address - Phone:801-626-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program