Provider Demographics
NPI:1326035049
Name:PETREE, CANDACE CHURCHWELL (PNP-C)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:CHURCHWELL
Last Name:PETREE
Suffix:
Gender:F
Credentials:PNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SUMMIT CROSSING PL
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2216
Mailing Address - Country:US
Mailing Address - Phone:704-671-6300
Mailing Address - Fax:704-671-6307
Practice Address - Street 1:705 SUMMIT CROSSING PL
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2216
Practice Address - Country:US
Practice Address - Phone:704-671-6300
Practice Address - Fax:704-671-6307
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00300347363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics