Provider Demographics
NPI:1497123871
Name:MILLER, CANDACE (MS, PA-C)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 AVENIDA VISTA GRANDE # B7-302
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9198
Mailing Address - Country:US
Mailing Address - Phone:505-391-4242
Mailing Address - Fax:505-439-7052
Practice Address - Street 1:1751 CALLE MEDICO STE O
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4706
Practice Address - Country:US
Practice Address - Phone:505-391-4242
Practice Address - Fax:505-439-7052
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA-2015-0062202D00000X
NMPA2015-0062363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical