Individual
CANDACE J TALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
HWY 180 MP 394.3, KAYENTA, AZ 86033-0368
(928) 697-4100
Mailing address
PO BOX 368, KAYENTA, AZ 86033-0368
(928) 697-4100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN217242
AZ
163WE0003X
Emergency Registered Nurse
RN217242
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060012
—
AZ
Enumeration date
10/21/2025
Last updated
10/21/2025
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