Provider Demographics
NPI:1770592495
Name:BERING, CANDACE RAE (PA-C)
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:RAE
Last Name:BERING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:R
Other - Last Name:KNUDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9010
Mailing Address - Fax:920-663-9012
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:MAYFAIRE TOWNER NORTH SUITE 810
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1309
Practice Address - Country:US
Practice Address - Phone:414-771-1122
Practice Address - Fax:414-771-1352
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1590-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant