Provider Demographics
NPI:1164300406
Name:OTOOLE, KANDICE (RN)
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:
Last Name:OTOOLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 NE 109TH CT STE A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6104
Mailing Address - Country:US
Mailing Address - Phone:360-727-1641
Mailing Address - Fax:
Practice Address - Street 1:5500 NE 109TH CT STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6104
Practice Address - Country:US
Practice Address - Phone:360-727-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2958552163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice