Provider Demographics
NPI:1528683547
Name:HAWORTH, CANDACE JOYCE (RDN)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:JOYCE
Last Name:HAWORTH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 ROSE SAGE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-5050
Mailing Address - Country:US
Mailing Address - Phone:702-738-0543
Mailing Address - Fax:
Practice Address - Street 1:5950 ROSE SAGE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-5050
Practice Address - Country:US
Practice Address - Phone:702-738-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV86150993133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered