Candace Marie Vander Wal, MS, LAT, ATC, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

683-15 Issued in ND

Practice address

3451 N 14TH St Ste C
Bismarck, ND 58503-1611

Phone

(701) 323-1125

NPI assigned

Jun 7, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559865600000",
    "number": "1225697899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3451 N 14TH ST STE C",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585031611",
            "telephone_number": "701-323-1125",
            "fax_number": "701-323-1180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3451 N 14TH ST STE C",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585031611",
            "telephone_number": "701-323-1125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER WAL",
        "first_name": "CANDACE",
        "middle_name": "MARIE",
        "credential": "MS, LAT, ATC, CSCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-07",
        "last_updated": "2019-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ND",
            "license": "683-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sarah Lee Vancleave, D.C.
• April Vander Hulst, PTA
• Jaclyn A Vander Linden, PA-C
• Kristen Vandervorst, LSW
• Scott Vandyke
• Carol Marie Vaneckhout
• Clarissa Beth Vangorkom
• Michelle Vanklootwyk, FNP-C

• Athletic Trainer in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Athletic Trainer in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.