Doctor Name: | CANDIS M TOOTHMAN |
NPI Number: | 1417352287 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 73558 |
Business Practice Address: | 597 Libert Street Suite 15 West Milford, WV - 26451 |
Business Phone Number: | 3047454568 |
Business Fax Number: | 3043263700 |
Mailing Address: | 597 Liberty Street, WEST MILFORD |
State: | WV |
Postal Code: | 26451 |
Phone Number: | 3047454568 |
Fax Number: | 3043263700 |
NPI Enumeration Date: | 10/23/2014 |
NPI Last Update Date: | 08/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 73558 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |