Provider Demographics
NPI:1184689317
Name:KUBEK, CANDACE (CRNP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:KUBEK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N 17TH ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5034
Mailing Address - Country:US
Mailing Address - Phone:610-437-0711
Mailing Address - Fax:610-437-9265
Practice Address - Street 1:401 N 17TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5034
Practice Address - Country:US
Practice Address - Phone:610-437-0711
Practice Address - Fax:610-437-9265
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006585B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07680196Medicaid
PAP33832Medicare UPIN
PA07680196Medicaid