Provider Demographics
NPI:1811751167
Name:JEANNOTTE, CANDACE M
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:M
Last Name:JEANNOTTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WASHINGTON AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5242
Mailing Address - Country:US
Mailing Address - Phone:701-833-1991
Mailing Address - Fax:
Practice Address - Street 1:309 WASHINGTON AVE STE 402
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5242
Practice Address - Country:US
Practice Address - Phone:701-833-1991
Practice Address - Fax:701-223-2843
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist