Healthcare Provider Details

I. General information

NPI: 1508301573
Provider Name (Legal Business Name): CANDACE EDWARDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 03/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 OWEN DR
FAYETTEVILLE NC
28304-3432
US

IV. Provider business mailing address

2641 CAMERON WOODS LN
FAYETTEVILLE NC
28306-7700
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 252-289-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009157
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: