Provider Demographics
NPI:1992237648
Name:ADAMS, CANDICE ELAINE (DNP, APRN, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ELAINE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DNP, APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 N MAIDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1367
Mailing Address - Country:US
Mailing Address - Phone:208-577-8672
Mailing Address - Fax:208-939-6106
Practice Address - Street 1:5108 N MAIDSTONE WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1367
Practice Address - Country:US
Practice Address - Phone:208-577-8672
Practice Address - Fax:208-939-6106
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55016363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care