Individual
CANDICE LAUREN RAYNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2170 SOUTH AVE, SOUTH LAKE TAHOE, CA 96150-7026
(530) 543-5497
(530) 541-8683
Mailing address
1111 EMERALD BAY RD, SOUTH LAKE TAHOE, CA 96150-6207
(530) 543-5659
(530) 541-8723
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
21581
CA
Other
Enumeration date
06/14/2012
Last updated
07/16/2014
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