| NPI | 1235589433 |
|---|---|
| Former Name | CANDACE TIETSWORTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0001230) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2019-07-23 |