Provider Demographics
NPI:1720450901
Name:LAWER-JOHNSON, CANDACE VICTORIA (NP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:VICTORIA
Last Name:LAWER-JOHNSON
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 1:135 ALLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-2301
Mailing Address - Country:US
Mailing Address - Phone:803-360-4991
Mailing Address - Fax:877-870-2854
Practice Address - Street 1:501 W BUTLER AVE
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-1313
Practice Address - Country:US
Practice Address - Phone:864-445-2250
Practice Address - Fax:877-870-2854
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3767Medicaid
SC7736Medicare UPIN