Provider Demographics
NPI:1659046878
Name:HOLSTEIN, CANDACE CULLER (NP)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:CULLER
Last Name:HOLSTEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-3125
Mailing Address - Country:US
Mailing Address - Phone:803-533-0148
Mailing Address - Fax:
Practice Address - Street 1:1177 LEE BLVD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-3125
Practice Address - Country:US
Practice Address - Phone:803-533-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23699363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care