Provider Demographics
NPI:1457763245
Name:PASSARO, CANDACE PARKS
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:PARKS
Last Name:PASSARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 SEATTLE SLEW LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5408
Mailing Address - Country:US
Mailing Address - Phone:910-384-2276
Mailing Address - Fax:
Practice Address - Street 1:1206 SEATTLE SLEW LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5408
Practice Address - Country:US
Practice Address - Phone:910-384-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5027367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered