Provider Demographics
NPI:1689633372
Name:KASPER, CANDICE J (CNP)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:J
Last Name:KASPER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:J
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1690 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 570
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3723
Mailing Address - Country:US
Mailing Address - Phone:651-232-4800
Mailing Address - Fax:651-232-4899
Practice Address - Street 1:1690 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 570
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3723
Practice Address - Country:US
Practice Address - Phone:651-232-4800
Practice Address - Fax:651-232-4899
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR078265-8363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS08896Medicare UPIN