Basic Information
| Provider Information | |||||||||
| NPI: | 1386738318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IRBY | ||||||||
| FirstName: | CANDACE | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1519 WILBURN PARK LN | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282696990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047660075 | ||||||||
| FaxNumber: | 7047661296 | ||||||||
| Practice Location | |||||||||
| Address1: | 249 BILLINGSLEY RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282111003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043364664 | ||||||||
| FaxNumber: | 7043310859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 152172 | NC | Y | Nursing Service Providers | Registered Nurse | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 15145 | 01 | NC | PROVIDER NUMBER | OTHER |