Provider Demographics
NPI:1871005819
Name:DEVERELL, CANDACE VERA (CRNP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:VERA
Last Name:DEVERELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:24 ANTRIM COMMONS DR
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1623
Practice Address - Country:US
Practice Address - Phone:717-593-0512
Practice Address - Fax:717-839-6810
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP017967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14142792OtherCAQH