Provider Demographics
NPI:1336191840
Name:MORTON, CANDACE S (APNP)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:S
Last Name:MORTON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:S
Other - Last Name:BUCKLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC CARDIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2380
Mailing Address - Fax:414-266-7251
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC CARDIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2380
Practice Address - Fax:414-266-7251
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2053363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000017792POtherHUMANA
WI1336191840Medicaid
000017792POtherHUMANA
Q19577Medicare UPIN