Provider Demographics
NPI:1245678820
Name:ROUNDTREE, CANDACE D
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:D
Last Name:ROUNDTREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N 57TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2207
Mailing Address - Country:US
Mailing Address - Phone:414-350-0090
Mailing Address - Fax:
Practice Address - Street 1:2501 N 57TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2207
Practice Address - Country:US
Practice Address - Phone:414-350-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WINRSMA 300-221G163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care