Candace Marilyn Hagenauer, LMT
Individual provider Active NPI Contractor · Woodburn, OR
NPI 1295982023 · NPPES record last updated Aug 22, 2008
Key facts
- NPI
- 1295982023
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 14682 (OR)
- Practice address
- 561 Arthur St
Woodburn, OR 97071-4713 - Phone
- (503) 981-9344
- NPI assigned
- Aug 22, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14682 | OR | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 14682 | OR | Yes |
Addresses
Primary practice location
561 Arthur St
Woodburn, OR 97071-4713
Mailing address
561 Arthur St
Woodburn, OR 97071-4713
Phone (503) 981-9344
Other providers in Woodburn, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.