Provider Demographics
NPI:1447270962
Name:CHITSAZ, CANDACE RICHARDSON (FNP)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:RICHARDSON
Last Name:CHITSAZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ASHVILLE AVENUE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6669
Mailing Address - Country:US
Mailing Address - Phone:919-233-6000
Mailing Address - Fax:919-233-6052
Practice Address - Street 1:222 ASHVILLE AVENUE
Practice Address - Street 2:SUITE 10
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6669
Practice Address - Country:US
Practice Address - Phone:919-233-6000
Practice Address - Fax:919-233-6052
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q19631Medicare UPIN
2809496Medicare ID - Type Unspecified