Healthcare Provider Details

I. General information

NPI: 1346004769
Provider Name (Legal Business Name): CANDACE MARTINDALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 DUKE MEDICINE CIRCLE DUKE CANCER CENTER CLINIC 5-1
DURHAM NC
27710-0001
US

IV. Provider business mailing address

1000 WILD SONNET CT
APEX NC
27502-9206
US

V. Phone/Fax

Practice location:
  • Phone: 919-668-8108
  • Fax:
Mailing address:
  • Phone: 919-454-4594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number247328
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG08230104
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: