Provider Demographics
NPI:1295172732
Name:BORDING, CANDACE MARI
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:MARI
Last Name:BORDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14129 S SHOREVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-9345
Mailing Address - Country:US
Mailing Address - Phone:509-299-9184
Mailing Address - Fax:
Practice Address - Street 1:14129 S SHOREVIEW DR
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-9345
Practice Address - Country:US
Practice Address - Phone:509-299-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA910926049OtherSCHOOL DISTRICT