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General NPI Number Information
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NPI Number | 1326603564
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Entity Type | Individual
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Provider Name | CANDICE PROCTOR STILLER NP
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1955 S US 29 HWY
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City | CHINA GROVE
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State | NC
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Zip | 28023-5684
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Country | US
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Telephone | 704-855-7611
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Fax | 704-855-7612
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 336-475-6139
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Fax | 336-475-3331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5011721
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License Number State | NC
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