Individual
CANDICE DIANE MOAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
355 W 16TH ST, SUITE 5100, INDIANAPOLIS, IN 46202-2207
(317) 396-1300
(317) 924-8472
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28170182A
IN
363L00000X
Nurse Practitioner
71004660A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71004660A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001028014
ANTHEM PTAN
IN
01
—
000001297548
ANTHEM PTAN
IN
05
—
201212670
—
IN
Enumeration date
07/09/2013
Last updated
02/13/2025
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