Provider Demographics
NPI:1619629813
Name:HALL, CANDACE PHILLIPS (MSN,APRN,FNP-C,IBCLC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:PHILLIPS
Last Name:HALL
Suffix:
Gender:F
Credentials:MSN,APRN,FNP-C,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 FAYETTEVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2707
Mailing Address - Country:US
Mailing Address - Phone:910-738-9599
Mailing Address - Fax:
Practice Address - Street 1:4320 FAYETTEVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2707
Practice Address - Country:US
Practice Address - Phone:910-738-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF01220625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily