Active NPI
Candice Lauren Raynor, NP
- Nurse Practitioner
- South Lake Tahoe, CA
National Provider Identifier
1134481104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 21581
- Practice address
- 2170 South Ave
South Lake Tahoe, CA 96150-7026 - Phone
- (530) 543-5497
- Fax
- (530) 541-8683
- NPI assigned
- Jun 14, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 21581 | CA | Primary |
Addresses
Primary practice location
2170 South Ave
South Lake Tahoe, CA 96150-7026
Mailing address
1111 Emerald Bay Rd
South Lake Tahoe, CA 96150-6207
Phone (530) 543-5659
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21581 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405468800000",
"number": "1134481104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 EMERALD BAY RD",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506207",
"telephone_number": "530-543-5659",
"fax_number": "530-541-8723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2170 SOUTH AVE",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961507026",
"telephone_number": "530-543-5497",
"fax_number": "530-541-8683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAYNOR",
"first_name": "CANDICE",
"middle_name": "LAUREN",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-14",
"last_updated": "2014-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "21581",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lake Tahoe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.