Individual
CANDICE NGWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
13737 NOEL ROAD, STE 1400, DALLAS, TX 75240-2004
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 650426, DALLAS, TX 75265-0426
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
679506
TX
367500000X
Certified Registered Nurse Anesthetist
RN187990
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200394110A
—
OK
05
—
210184205
—
TX
01
—
8853UA
BLUE SHIELD
TX
05
—
948795930A
—
GA
05
—
948795930B
—
GA
01
—
P00928962
RAILROAD
TX
Enumeration date
06/01/2007
Last updated
10/05/2016
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