Healthcare Provider Details

I. General information

NPI: 1255414413
Provider Name (Legal Business Name): CANDACE MARIE FERENCIK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 RIDGE RD
ROXBORO NC
27573-4629
US

IV. Provider business mailing address

DUKE UNIVERSITY MEDICAL CTR DUMC 3094
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-503-5640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3044
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: