Basic Information
| Provider Information | |||||||||
| NPI: | 1639760358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FUTCH | ||||||||
| FirstName: | CANDIS | ||||||||
| MiddleName: | RACHEL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 N ARIZONA AVE APT 1115 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852251255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286074491 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 AZ-89 | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2021 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 136A00000X | 86151341 | AZ | N | Dietary & Nutritional Service Providers | Dietetic Technician, Registered | 133V00000X | 86151341 | AZ | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.