Provider Demographics
NPI:1487919957
Name:PENDOWSKI, CANDACE NOEL (ACNP)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:NOEL
Last Name:PENDOWSKI
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 HOSPITAL STREET SUITE 208
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581
Mailing Address - Country:US
Mailing Address - Phone:228-762-5982
Mailing Address - Fax:228-769-7698
Practice Address - Street 1:4211 HOSPITAL ST SUITE 208
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581
Practice Address - Country:US
Practice Address - Phone:228-762-5982
Practice Address - Fax:228-769-7698
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872680363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner