Basic Information
| Provider Information | |||||||||
| NPI: | 1629024997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | CANDICE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5074 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053127605 | ||||||||
| FaxNumber: | 6053127611 | ||||||||
| Practice Location | |||||||||
| Address1: | 6101 S LOUISE AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571085981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053128000 | ||||||||
| FaxNumber: | 6053128001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 05/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4890 | SD | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | R-5860 | IA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.