Provider Demographics
NPI:1013125632
Name:DISANTI, CANDICE A (CNM)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:A
Last Name:DISANTI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0536
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-651-0794
Practice Address - Street 1:406 E GIBBSBORO RD
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-1907
Practice Address - Country:US
Practice Address - Phone:856-435-7007
Practice Address - Fax:856-435-3866
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10117400367A00000X
NJ25ME00043601367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife