Provider Demographics
NPI:1538337555
Name:RYAN, CANDACE LYNN (PAC)
Entity type:Individual
Prefix:MISS
First Name:CANDACE
Middle Name:LYNN
Last Name:RYAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:LYNN
Other - Last Name:NEBRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:4550 E. BELL ROAD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:480-443-8400
Mailing Address - Fax:480-443-8697
Practice Address - Street 1:5601 W. EUGIE AVE.
Practice Address - Street 2:SUITE 204
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:480-443-8400
Practice Address - Fax:480-443-8697
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3762363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant