| Doctor Name: | DR. CANDACE MARIE TULL |
| NPI Number: | 1811092810 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD, WHCNP |
| License Number: | 30706.1178 |
| Business Practice Address: | 107736 Hwy 89 Etna, WY - 83118 |
| Business Phone Number: | 2102155222 |
| Business Fax Number: | |
| Mailing Address: | Hc 62 Box 7466, STAR VALLEY RANCH |
| State: | WY |
| Postal Code: | 831277004 |
| Phone Number: | 2102155222 |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 06/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | 30706.1178 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |