Provider Demographics
NPI:1326378662
Name:DAVIS, CANDACE MCWHIRTER (FNPC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:MCWHIRTER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:L
Other - Last Name:MCWHIRTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:775 RED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3227
Mailing Address - Country:US
Mailing Address - Phone:207-300-3675
Mailing Address - Fax:888-226-6431
Practice Address - Street 1:775 RED BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3227
Practice Address - Country:US
Practice Address - Phone:207-300-3675
Practice Address - Fax:888-226-6431
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH072896-23363LF0000X
MECNP201167363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCH005B897Medicare PIN