Individual
CANDUS NICOLE ANTOLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9923A E. JOHNSON ST, MADIGAN ANNEX, JBLM, TACOMA, WA 98498
(253) 968-6485
Mailing address
9923A E. JOHNSON ST, MADIGAN ANNEX, JBLM, TACOMA, WA 98498
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD-21233
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VAD000
MEDICARE UPIN
—
Enumeration date
03/01/2018
Last updated
04/03/2025
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